Diabetic Foot Ulcers: Appraising Standard of Care and Reviewing New Trends in Management

Diabetic foot ulcers (DFU) are one of the most common diabetes complications and are associated with significant morbidity and mortality. Current DFU standard of care (SOC) involves four principles: (1) pressure relief, (2) debridement, (3) infection management, and (4) revascularization when indicated. Despite the current SOC, many DFU persist, warranting a new approach for the management of these complex wounds. This review aims to summarize the current SOC as well as the latest trends in adjunctive therapies that may become the new SOC in DFU management. These include negative pressure wound therapy and hyperbaric oxygen therapy, bioengineered skin substitutes, growth factors, shockwave therapy, and several others. These novel therapies have shown significant DFU clinical improvement among subsets of DFU patients. However, much of the literature comes from smaller trials with inconsistent patient selection and outcomes measured, making it difficult to assess the true clinical benefit of these treatments. While novel therapies are promising for the interdisciplinary approach to DFU management, many still lack sufficient evidence, and their efficacy remains to be determined.