Advancing Diabetic Foot Ulcer Care: Focus on the Post-Healing Transition Phase

The recurrence of diabetic foot ulcers (DFUs) brings significant morbidity to people with diabetes and adds to healthcare costs. According to current guidelines, a DFU is considered healed when it is re-epithelialized, and the wound closure is maintained for around 2 weeks. However, recent literature suggests that the mechanical properties of the underlying plantar tissues remain altered, thus making the foot vulnerable to recurrence. The period lasting several weeks post-DFU healing can be termed the 'transition phase'. This review aimed at exploring this critical phase, with an emphasis on the roles of tissue mechanics and current offloading strategies. An extensive search was performed on PubMed to identify studies on the mechanical properties of the tissues and preventative strategies in the post-healing period. Following the analysis of titles and abstracts, 57 studies met the inclusion criteria and were included in the review. The analysis of the literature revealed that studies are primarily focused on offloading interventions during the remission phase to mitigate long-term ulceration risks. The physiological needs of the still-vulnerable plantar soft tissue after DFU healing are seldom assessed, and no strict differentiation between re-ulceration and recurrent ulceration has been found. According to this review, there is a need for developing beyond state-of-the-art solutions targeting pressure relief and footwear adherence, which consider the varying physiological conditions of the skin and underlying tissue in the transition phase, and the different risk categories and independent risk factors.