Smart Wearables Are Transforming Diabetic Foot Care Before Ulcers Form

Diabetic foot disease is the leading cause of non-traumatic lower-limb amputation globally, responsible for over 85% of such procedures, and carries a five-year ulcer recurrence rate of 65%. With global Type 2 diabetes healthcare spending exceeding $966 billion in 2021, the need for more proactive, continuous, and cost-effective management tools is urgent. This 2025 systematic review directly addresses that gap by synthesizing research on smart wearable technology for diabetic foot prevention, assessment, and management.

The authors searched Scopus and PubMed using a structured query covering diabetes, foot, sensors, pressure, shear, temperature, humidity, oxygenation, and pH, spanning publications from 2012 to July 2024. After applying inclusion criteria and a multi-step screening process, 98 high-quality peer-reviewed studies were retained for analysis. Research output in this field accelerated sharply around 2021–2022, with the highest concentrations of publications originating from the United States, India, the United Kingdom, and China, reflecting global urgency.

The review organized findings into sensorized and unsensorized wearable categories. Sensorized wearables encompass insoles and sock-based systems that continuously measure plantar pressure and shear forces at high-risk anatomical zones—hallux, metatarsal heads, midfoot, and heel—alongside physiological parameters including skin temperature, moisture/humidity, microcirculation, and wound-bed pH. Elevated plantar pressure and abnormal temperature gradients (particularly asymmetric inter-foot differences exceeding 2.2°C) emerged as the most clinically validated early warning signals for impending ulceration. pH sensors embedded in smart dressings and insoles can signal wound infection or impaired healing, since chronic wounds shift toward alkalinity. Microcirculation and transcutaneous oxygen sensors complement vascular assessment by quantifying perfusion deficits that standard ankle-brachial index tests can miss.

Unsensorized wearables—including 3D-printed custom insoles using pressure-redistributing smart materials such as shape-memory polymers and silicone composites—demonstrated significant potential for offloading high-pressure zones without electronic components, improving accessibility and durability. Vibrotactile feedback actuation systems represent an emerging therapeutic frontier: by delivering sensory substitution stimuli to the plantar surface, they partially compensate for peripheral neuropathy-induced sensory loss, reducing fall risk and abnormal gait patterns that drive ulcer formation. AI and machine learning algorithms applied to multi-sensor data streams were shown to improve early ulcer prediction accuracy, personalize pressure thresholds, and flag anomalies for remote clinician review via telehealth platforms.

The review highlights that no single parameter is sufficient; the integration of mechanical, physiological, and biochemical sensor data into unified wearable platforms—supported by AI analytics and telemedicine—offers the most promising route to closing current gaps in diabetic foot care. Key remaining challenges include sensor durability under real-world conditions, patient adherence, data standardization, regulatory pathways, and equitable access across healthcare settings.