Abstract

Diabetic foot ulcers (DFUs) continue to represent one of the most significant and
costly complications related to diabetes mellitus, posing serious challenges to
healthcare systems and resulting in considerable morbidity rates. This narrative
review explores the complex pathophysiology of DFUs, focusing on the interplay
between peripheral neuropathy, vascular insufficiency, and a weakened immune
response, all of which contribute to delayed wound healing. Neuropathy leads to a
loss of protective sensation, causing unnoticed repetitive injuries, while both
microvascular and macrovascular complications reduce tissue perfusion and
hinder angiogenesis. Additionally, immune dysfunction and exaggerated
inflammatory responses raise the occurrence of infection and negatively affect the
healing process. The clinical manifestation, progression, and key risk factors of DFUs
were discussed in this review, emphasizing the importance of early detection, careful
foot care, and routine screening in individuals who are at risk. Numerous therapeutic
approaches are reviewed, including wound debridement, sophisticated wound
dressings, offloading techniques, glycemic control, and adjuvant therapies such as
growth factor administration, hyperbaric oxygen therapy, and negative pressure
wound therapy. For optimal results, a multidisciplinary team combining of vascular
surgeons, podiatrists, endocrinologists, and wound care specialists was included. The
analysis also points out that promising advancements in bioengineered skin
substitutes, intelligent dressings, and regenerative medicine hold promise for the
treatment of DFU in the future. Self-monitoring, appropriate footwear, and patient
education are all important components of prevention, which remains a fundamental
strategy. In the clinical management of DFUs, this narrative review incorporates the
most recent research and highlights the value of proactive, customized, and
multidisciplinary approaches.