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. 2025 Jul 18;22(1):168.
doi: 10.1186/s12984-025-01695-9.

Diabetic foot prevention, assessment, and management using innovative smart wearable technology: a systematic review

Doua Kosaji  1 , Mohammad I Awad  2 , Rateb Katmah  1 , Herbert F Jelinek  3   4 , M Fatima Domingues  1   3   5 , Mohamed Baguneid  6 , Abeer Alanazi  7 , Kinda Khalaf  8   9
Affiliations

Diabetic foot prevention, assessment, and management using innovative smart wearable technology: a systematic review

Doua Kosaji et al. J Neuroeng Rehabil. .

Abstract

The diabetic foot (DF) is a chief culprit behind significant preventable morbidity and mortality in type-2-diabetes patients and the leading cause of non-traumatic lower-extremity amputations. Despite the clinically well-understood pathways to ulceration, including neuropathy, ischemia, and infection, DF continues to impose a significant health and economic burden on patients and healthcare systems. Recent technological developments in sensing, smart miniaturized wearable technology, and artificial intelligence provide ample options for viable solutions. A continuous monitoring wearable system that alerts patients and healthcare providers could enhance current detection and management protocols. Quantification of both mechanical (plantar-pressure and shear-forces) and physiological/wound-associated parameters (temperature, humidity, vascular, microcirculation, and pH) underlying the pathophysiology of DF provides opportunities for improving the assessment of DF and treatment outcomes. This review bridges this knowledge gap by exploring the integration of current state-of-the-art sensing modalities and smart wearables with novel actuation technology for real-time management towards effective wound healing of the DF.

Keywords: Diabetic foot; Diabetic neuropathy; Peripheral vascular diseases (PVD); Sensors.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
(a) Search and screening process flowchart, (b) Publications per year, showing a notable increase in academic publications in recent years, particularly 2021 and 2022, (c) Publications worldwide with the highest concentration of publications in the United States, India, United Kingdom, and China
Fig. 2
Fig. 2
(a) The triad of Infection, Peripheral Vascular Disease (PVD), and Diabetic Peripheral Neuropathy (DPN) and their related attributes, (b) ROI are more susceptible to ulcerations. They include the hallux, metatarsal heads, midfoot, and heel
Fig. 3
Fig. 3
Various sensing mechanisms used in wearables for the management of diabetic foot (a) Scheme of main layers that make up the proposed plantar insole capacitive PDMS [28] CC-BY license, (b) Pressure and shear monitoring using three-coil induction force sensor [36] ©2015 IEEE, (c) Prototype system proposed to monitor and analyze gait by looking specifically at the foot force and the plantar flexion using FSR and FBS sensors [39] CC-BY license
Fig. 4
Fig. 4
(a) The sensing mechanism of FBG sensors [55] ©2019 IEEE, (b) A diagram showing FBG sensors integrated into a shoe insole [55] ©2019 IEEE
See this image and copyright information in PMC

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