A comprehensive biomechanical phenotyping framework for diabetic foot ulcer risk stratification using multi-modal gait analysis and machine learning.

Introduction Diabetes is a rapidly growing global health concern, with the World Health Organization (WHO) estimating that 300 million adults will have diabetes by 2025. This chronic condition is associated with complications, including nephropathy, retinopathy, neuropathy, cardiovascular disease, and diabetic foot ulcers (DFUs), which can lead to amputation. Diabetic septic foot (DSF), a severe form of diabetic foot disease, is defined by the WHO as the presence of infection, ulceration, or tissue destruction in the lower limb, often accompanied by neurological abnormalities, peripheral vascular disease, and metabolic complications of diabetes. In Sudan, the incidence of lower limb amputations due to DSF is increasing, with various healthcare centers employing different management strategies, making it challenging to identify which factors are most strongly linked to the highest rates of amputations. This study aims to identify the key risk factors contributing to amputations in patients with diabetic foot syndrome (DFS) in Khartoum, Sudan. Specifically, it seeks to assess the common risk factors for amputation in diabetic septic foot patients at hospital wards and dressing centers in Khartoum State, Sudan. Objectives include identifying risk factors associated with amputations, determining the types and frequency of amputations, and evaluating diabetes control and foot self-care practices. MethodsThis was a descriptive cross-sectional study that was conducted anonymously between 01/11/2017 and 08/11/2017 in various hospital wards and dressing centers in Khartoum, Sudan, on 46 diabetic septic foot patients. Data was collected using an interview questionnaire and checklist administered to the attending patients. Quantitative data was analyzed using IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp. This paper aims to explore the pathophysiology, risk factors, and clinical management of diabetic foot complications, with a focus on preventing the devastating outcome of amputation. ResultsThe findings revealed that the most significant risk factors for amputation included a raised HbA1c level (74%), male gender (78%), age over 50 years (96%), and a history of preceding non-healing ulcers (93.5%). Other factors, such as smoking, diabetes-related comorbidities, and the type of diabetes management, showed no significant association with amputation. Normal saline and iodine were the most commonly used wound care solutions (52%). Regarding foot care habits, the most frequently practiced measures among patients included wearing special diabetic shoes (63%), avoiding walking barefoot (63%), and refraining from smoking (59%).ConclusionsThis study identified key risk factors for amputations in diabetic septic foot (DSF) patients, including elevated HbA1C levels, male gender, age over 50, and a history of unhealing ulcers, with poor foot care practices contributing to higher amputation rates. The findings highlight the importance of glycemic control, foot hygiene, and patient education in preventing amputations. Additionally, the study underscores the need for comprehensive management strategies that address both metabolic control and foot care, particularly in resource-limited settings. These insights can guide local healthcare policies focused on prevention, early intervention, and better resource allocation to reduce diabetes-related complications and improve patient outcomes.

Diabetic foot complications impose a significant strain on healthcare systems worldwide, acting as a principal cause of morbidity and mortality in individuals with diabetes mellitus. While traditional methods in diagnosing and treating these conditions have faced limitations, the emergence of Machine Learning (ML) technologies heralds a new era, offering the promise of revolutionizing diabetic foot care through enhanced precision and tailored treatment strategies. This review aims to explore the transformative impact of ML on managing diabetic foot complications, highlighting its potential to advance diagnostic accuracy and therapeutic approaches by leveraging developments in medical imaging, biomarker detection, and clinical biomechanics. A meticulous literature search was executed across PubMed, Scopus, and Google Scholar databases to identify pertinent articles published up to March 2024. The search strategy was carefully crafted, employing a combination of keywords such as "Machine Learning," "Diabetic Foot," "Diabetic Foot Ulcers," "Diabetic Foot Care," "Artificial Intelligence," and "Predictive Modeling." This review offers an in-depth analysis of the foundational principles and algorithms that constitute ML, placing a special emphasis on their relevance to the medical sciences, particularly within the specialized domain of diabetic foot pathology. Through the incorporation of illustrative case studies and schematic diagrams, the review endeavors to elucidate the intricate computational methodologies involved. ML has proven to be invaluable in deriving critical insights from complex datasets, enhancing both the diagnostic precision and therapeutic planning for diabetic foot management. This review highlights the efficacy of ML in clinical decision-making, underscored by comparative analyses of ML algorithms in prognostic assessments and diagnostic applications within diabetic foot care. The review culminates in a prospective assessment of the trajectory of ML applications in the realm of diabetic foot care. We believe that despite challenges such as computational limitations and ethical considerations, ML remains at the forefront of revolutionizing treatment paradigms for the management of diabetic foot complications that are globally applicable and precision-oriented. This technological evolution heralds unprecedented possibilities for treatment and opportunities for enhancing patient care.

Diabetic foot complications are a major cause of lower limb amputation, with delayed risk identification and inconsistent documentation contributing to poor outcomes, particularly in resource-limited settings. This clinical audit aimed to improve early identification and documentation of high-risk diabetic foot complications at Almanagil Teaching Hospital. A closed-loop clinical audit was conducted over two cycles at Almanagil Teaching Hospital. Fifty consecutive medical records of patients with diabetes presenting with diabetic foot ulcers or suspected infection were reviewed in each cycle. Following a baseline assessment, a targeted quality improvement intervention was implemented, including staff education and the introduction of a standardized diabetic foot risk assessment and scoring tool. Documentation practices before and after the intervention were compared using descriptive and inferential statistics. At baseline, documentation was incomplete across most domains, with patient identifiers recorded in 22%-60% of records and key clinical assessments such as neuropathy, peripheral arterial disease, and infection documented in only 8%-18%. Following the intervention, documentation of patient and clinician identification reached 100%, while neuropathy and peripheral arterial disease assessments increased to 98% and 96%, respectively. Infection and skin integrity assessment improved from 8% to 94%, and objective risk stratification using total risk score calculation increased from 2% to 92%. Documentation of follow-up or clinical intervention rose from 22% at baseline to 96% post-intervention. All improvements between Cycle 1 and Cycle 2 were statistically significant (χ² tests, p < 0.001). Implementation of a structured diabetic foot risk assessment tool supported by focused education was associated with marked improvements in documentation and early risk identification. These findings highlight the effectiveness of audit-driven quality improvement strategies in strengthening diabetic foot care processes and support their wider adoption in similar healthcare settings.

Diabetes is a serious chronic disease that results in foot complications for many people world-wide. In 2014, the World Health Organization estimated the global prevalence of diabetes in adults to be 9%. To ascertain the risk that an individual patient might develop a diabetic foot ulcer that could lead to an amputation, clinicians are strongly encouraged to perform a risk assessment. Monteiro-Soares and Dinis-Ribeiro have presented a new DIAbetic FOot Risk Assessment with the acronym DIAFORA. It is different from other risk assessments in that it predicts the risk of developing both diabetic foot ulcers and amputation specifically. The risk variables were derived by regression analysis based on a data set of 293 patients from a high-risk setting, a Hospital Diabetic Foot Clinic, who had diabetes and a diabetic foot ulcers. Clear descriptions of the risk variables are provided as well as sensitivity, specificity, positive and negative predictive values for the risk categories. As an added benefit, likelihood ratios are provided that will help clinicians determine the risk of amputation for individual patients. Having a risk assessment form is important for clinician use and examples exist. A question is raised about the effectiveness of risk assessment and how effectiveness might be determined.

Diabetic foot disease greatly impacts both affected patients and society, but remains the “Cinderella” of diabetes‐related complications. However, recent progress in research and guideline development have led to increased awareness of the problem and improved clinical outcomes. Thus, it is time for a shift in global perception of this increasingly prevalent problem. In this special issue, we present 7 up‐to‐date clinical guidelines and 10 systematic reviews developed by the International Working Group on the Diabetic Foot, together with 17 informative and stimulating related papers. These guidelines offer new recommendations on ulcer classification, diagnosis of infection severity, and vascular assessment, to assist in ulcer risk stratification, diagnosis and interdisciplinary communication. Key developments include providing guidance on methodological assessment of research papers; expanding the evidence base for ulcer treatment by the use of wound products and offloading treatment and suggestions for improving ulcer prevention through technological advances in patient monitoring of risk factors and footwear. The 17 invited papers discuss related topics ranging from stem cell research to patient psychology and describe the way forward in diabetic foot care. While there is much more to learn, the new knowledge of underlying pathways, advancements in diagnosis, treatment and prevention presented in this supplement should help improve outcomes and reduce the great and growing burden of diabetic foot disease.

Gait analysis using three-dimensional motion capture systems (3D motion capture) provides a combination of kinematic and kinetic measurements for quantifying and characterizing the motion and loads, respectively, of lower extremity joints during human movement. However, their high cost and limited accessibility impact their utility. Wearable inertial motion sensors offer a cost-effective alternative to measure simple temporospatial variables, but more complex kinematic variables require machine learning interfaces. We hypothesize that kinematic measures about the knee collected using motion capture can be replicated by coupling raw data collected from inertial measurement units (IMUs) to machine learning algorithms. Data from 40 healthy participants performing fixed walking, stair climbing, and sit-to-stand tasks were collected using both 3D motion capture and IMUs. Sequence to sequence convolutional neural networks were trained to map IMU data to three motion capture kinematic outputs: right knee angle, right knee angular velocity, and right hip angle. Model performance was assessed using mean absolute error. The convolutional neural network models exhibited high accuracy in replicating motion capture-derived kinematic variables. Mean absolute error values for right knee angle ranged from 4.30 ± 1.55 to 5.79 ± 2.93 degrees, for right knee angular velocity from 7.82 ± 3.01 to 22.16 ± 9.52 degrees per second, and for right hip angle from 4.82 ± 2.29 to 8.63 ± 4.73 degrees. Task-specific variations in accuracy were observed. The findings highlight the potential of leveraging raw data from wearable inertial sensors and machine learning algorithms to reproduce gait lab-quality kinematic data outside the laboratory settings for the study of knee function following joint injury, surgery, or the progression of joint disease.

Background: Diabetic foot ulcers are one of the chronic complications of diabetes mellitus (DM) in the form of wounds on the skin surface of the feet of DM patients accompanied by internal tissue damage or tissue death, either with or without infection, which is associated with the presence of neuropathy and or peripheral arterial disease in patients with DM. The World Health Organization (WHO) states that at least 422 million people suffer from DM A new alternative parameter for assessing the degree of peripheral ischemia is ankle peak systolic velocity (PSV). The rationale for PSV is based on the observation that in the ischemic limb, blood travels at a much slower rate in the distal leg arteries than in the nonischemic limb. PSV is a quick and easy test to assess the patient's vascular status and monitor the development of diabetic foot ulcers, and can assess the degree of ischemia and predict healing of diabetic foot ulcers. This study aims to determine the Correlation of Peak Systolic Velocity Value with Wagner Score in Diabetic Foot Ulcer patients in RSUP Dr. M. Djamil Padang.&#x0D; Methods: This research is analytic observational with cross sectional design, the research uses primary data. This research will be conducted at the RSUP Dr. M. Djamil Padang from July 2021 to October 2021. The population in this study were diabetic foot ulcer patients who came for treatment at Dr. M. Djamil Padang. A sample of 32 patients Diabetic foot ulcer met the inclusion criteria. Univariate analysis was conducted to describe each of the variables studied. Numerical data is normally distributed, then it is presented in the form of mean ± standard deviation (SD), whereas if the numerical data is not normally distributed then it is presented in the form of median, minimum and maximum. Categorical data is presented in the form of frequency and percentage of each category. Bivariate analysis was started by using the data normality test using the Shapiro Wilk test (n&lt;50). In testing the correlation between Peak Systolic Velocity and Wagner Score in diabetic foot ulcer patients, the Pearson correlation test is used if the data is normally distributed. Data analysis using SPSS version 22.0.&#x0D; Results: more than half of the subjects (65.6%) are male. The mean age of the subjects was 60.46±10.06 years. More than half of the subjects (62.5%) had a normal body mass index. The average length of suffering from diabetes mellitus was 5.48 ± 2.26 years. Half had a history of smoking (59.4%), a small proportion of subjects had hypertension (21.9%), hypercholesterolemia (6.3%) and neuropathy (12.5%). More than half of the subjects (53.1%) had immunopathies. There is a correlation between the popliteal PSV value and the Wagner score in diabetic ulcer patients (p&lt;0.05), with a moderate correlation strength (r=-0.463) and a negative direction. There is a correlation between the PSV dorsali pedis value and the Wagner score in diabetic ulcer patients (p&lt;0.05), with a strong correlation strength (r=-0.720) and in a negative direction. Furthermore, there is a correlation between the posterior tibial PSV value and the Wagner score in diabetic ulcer patients (p&lt;0.05), with a moderate correlation strength (r=-0.530) and a negative direction.&#x0D; Conclusion: There is a correlation between the popliteal, tibialis posterior, dorsalis pedis PSV value and the Wagner score in diabetic foot ulcer patient

Background: Diabetic foot ulcers are a serious complication that increases morbidity and amputation risk in patients with diabetes mellitus. Self-care is an important aspect of diabetes management that includes various health behaviours, such as diet, exercise, blood sugar monitoring, medication adherence and foot care. Purpose: To measures the relationship between the level of self-care of patients with diabetes mellitus (DM) and the risk of diabetic foot ulcers. Method: This study uses Analytical research methods using a Crossectional study approach. The sample size in this study used total sampling, from January to early March 2025, totalling 66 respondents. Data analysis to find the relationship between variables using non-parametric correlation test analysis, namely Spearman Correlation with a meaning level of 95% (0.05) because the data is ordinal scale. Results: This study found that based on statistical tests there was a correlation between the level of self-care and the risk of diabetic foot ulcers with a p value of 0.000 &lt;0.05. Spearman's correlation value of 0.521 shows a positive correlation with a fairly strong correlation strength. Conclusion: The better the level of self-care of type 2 diabetes mellitus patients, the lower their risk of developing diabetic foot ulcers.

Background; diabetic foot patients are affected by complications with any injury, more than healthy people, as a result of the delay in discovering the problem, as the patient’s lack of awareness of repeated injuries leads to complications with difficulty in treatment, these disorders are related to controlling the level of sugar in the blood. 39 samples of diabetic foot patients were collected from Al-Rifai General Hospital and the Diabetes Center in Nasiriyah city to conduct histological examinations. Aims of the study; the current study aims to characterize the histopathological features of diabetic foot ulcer cases. And assess immune and biochemical parameters associated with diabetic foot ulcer. In addition to evaluate the correlation between histopathological changes and immune responses. Methodology; Samples (blood, tissue specimen) were collected from diabetic patients with diabetic foot ulcer from Al-Rifai General Hospital and the Diabetic Center in in Nasiriyah city from April 2022 to september2022. Histopathological sections were prepared according to (Bancroft and Steven, 2008) , cytokines (TGF- β, IFN- γ and IL-17A) measured using the enzyme-linked immunosorbent technique ELISA. Result; the current study aims to demonstrate the histopathological changes associated with diabetic foot. results show purulent ulcer with a large gap between the edges of the lesion necrotic foci in the dermis tissue, Fibrin deposition with focal melanin pigmentation, degenerative changes with compaction of nuclei and extensive granulation formation in the dermis with inflammatory activity. The results showed a significant increase in the concentration of some cytokines (TGF- β, IFN- γ and IL-17A) and some Biochemical parameters such as (HbA1C and Triglycerides) in patients with diabetic foot compared to the healthy group. Conclusions; The present study concluded that the severity of diabetic foot ulcers is closely related to the high level of cytokines in diabetic patients with a preponderance in type 1 diabetes Highlights: tudy examines histopathological changes in diabetic foot ulcer patients. Findings show necrosis, inflammation, elevated cytokines (TGF-β, IFN-γ, IL-17A). Diabetic foot severity linked to cytokines and biochemical imbalances. Keywords: Diabetic foot, gangrene, ulcer, TGF- β, IFN- γ and IL-17A

ObjectiveThis study aimed to comprehensively review the latest advancements in diabetic foot risk prediction models over the past four years to address the severe challenges posed by diabetic foot ulcers, which are among the leading causes of disability and mortality among diabetic patients. Diabetic foot ulcers are characterized by their complex aetiology, pose a grave threat to life and impose enormous social and economic burdens, thus becoming a critical issue in public health that urgently requires attention. By accurately predicting the risk of diabetic foot and implementing early intervention strategies, this study aimed to reduce its incidence and mortality rates.MethodsThis study employed a systematic review and comprehensive analysis framework, conducted extensive searches of electronic databases (including PubMed, EMBASE, the Cochrane Library, CNKI, etc.) and supplemented these searches with manual literature collection to ensure comprehensive information coverage. During the literature screening and evaluation phase, strict adherence to the predetermined inclusion and exclusion criteria was maintained to guarantee the high quality of the included studies. Further detailed quality assessments, data extraction, and analysis of the selected literature were conducted, with a focus on exploring the construction strategies of risk prediction models, the selection of key variables, the evaluation indicators of model performance, and the validation methods.ResultsBy comparing and analysing the differences among studies in terms of methodology, model effectiveness, and practical application potential, this study summarized the development trends of diabetic foot risk prediction models and anticipated future research directions. These findings indicate that with the assistance of advanced diabetic foot risk prediction models, potential risk factors can be identified and addressed early on, thereby effectively reducing the incidence of diabetic foot and significantly improving patients’ quality of life.ConclusionThis study revealed that diabetic foot risk prediction models have significant effects on accurately identifying risk factors and guiding early interventions, serving as effective tools to reduce the incidence of diabetic foot. Through early identification and intervention, the prognosis and quality of life of patients can be significantly improved, providing important references and guidance for the field of public health.

Background: The International Diabetes Federation states that India accounts for 1 in 7 of all adults living with diabetes worldwide. Diabetic foot disease is among the most serious complications of diabetes mellitus as it is a source of major suffering and financial burden for the patient, healthcare professionals and the society in general. The leading cause of lower-limb amputations is diabetes and 40%–85% of these are preventable Objective: Assessment of diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) consensus. Methodology: A community based cross-sectional study was done in Ernakulam district involving 600 individuals with diabetes mellitus. The study gathered information on sociodemographic factors, anthropometric details and a detailed foot examination was performed with a IWGDF checklist. The collected data were entered into MS Excel, and the analysis was carried out using SPSS 21.0. Results: Mean age of patients in the study was 61.48 yrs±10.24 years.371 patients (61.83%) were females and 229(38.17%) were males.108 patients (18%) had disturbed sense of vibration (128 Hz). 90 patients (15%) had decreased sensitivity to 10-gram monofilaments. Peripheral arterial disease was present in 47 patients (7.83). 20 patients (3.33%) had history of previous ulcer. 11(1.83%) patients had lower extremity amputation. Patients were classified into four risk groups according to IWGDF criteria. Four hundred and fifty-five patients (75.83%) were in group 0, fifty-five patients (9.1%) in group 1, sixty-six patients (11%) in group 2 and twenty-four patients (4%) in group 3 of IWGDF criteria Conclusion: Routine foot examination in patients with diabetes as per IWGDF guidelines for each risk category will help in prevention of diabetic foot ulcers.

Introduction: Diabetes mellitus is the leading cause of nontraumatic lower extremity amputation worldwide. Risk of developing a foot ulcer in diabetic patients has increased to 12-25% during their lifetime. Inappropriate sampling technique leading to contaminated samples is a well-known threat among patients of diabetic foot. In this study we compared two microbiological sampling techniques, superficial swabbing and deep tissue biopsy for identification of pathogens. Material and Methods: It was a prospective observational cross-sectional study. Diabetic foot was defined as per standard guidelines. Careful and meticulous examination of diabetic foot ulcer was done. Two specimens were collected from each wound. The first specimen was a wound swab collected by using Levine technique; another was taken via punch biopsy from the ulcer base. It was a deep tissue sample of 4 mm size. Results: A total of 120 diabetic patients with diabetic foot infection were included in this study. In swab culture 80.83% patients had mono microbial growth, 15% had polymicrobial and 4.10% had no growth. In deep tissue culture 87.50% had mono microbial growth, 2.50% had poly microbial and 10% were sterile. Staphylococcus aureus was most common isolate followed by E. coli. It was observed that though monomicrobial growth was most common in both the types of samples but was higher in deep tissue biopsy than in superficial swab samples. Conclusion: The isolation of microorganism via deep tissue sampling in diabetic foot ulcer patients is more reliable compared to superficial swab samples and a better guide to antibiotic therapy.

Diabetes Mellitus (DM) is a chronic metabolic disorder caused by the pancreas not using insulin effectively, if the management is not good, one of the risks of complications in DM patients is Diabetic Foot Ulcer. Behaviors at risk for causing Diabetic Foot Ulcer are smoking activities, physical activity, use of poor footwear, body mask index and glycemic control. The behavior of DM patients greatly influences the incidence of Diabetic Foot Ulcer, therefore it is very important to analyze the behavioral factors of DM patients who are at risk for Diabetic Foot Ulcer. The aim of this research is to analyze the behavioral factors that are at risk for the occurrence of Diabetic Foot Ulcer and to look for the most dominant factors that are at risk of causing Diabetic Foot Ulcer. The research was conducted using a descriptive method on 30 respondents using a total sampling technique. The data collection process used questionnaires about smoking activities, physical activity, use of poor footwear, body mask index and glycemic control. The results obtained for risk behaviors for Diabetic foot ulcers were 70% normal BMI, 93.7% had non-smoking habits, 50% did physical activity, 66.67% used footwear, 66.67% went on a diet and 100% did glycemic control . The behavior of DM patients who are at risk of developing Diabetic Foot Ulcer are all indicators only if sorted from the most dominant, namely Physical Activity, Diet and Use of Footwear, BMI, Smoking Habits and Glycemic Control. Suggestions for the pronalis program to provide education that emphasizes behavior that is at risk of developing diabetic foot ulcers. Key Word : Behavioral, Diabetes Mellitus, Diabetic Foot Ulcer,

Diabetes is the most common chronic disease worldwide. Although many serious complications can affect the individual with diabetes, foot problems take the greatest. This is an interventional quasi-experimental hospital-based study was conduct in King Fahd General Hospital in Jeddah, king of Saudi Arabia aimed at assessing the effective of health education program in knowledge, attitudes and practice of diabetic septic foot patient to prevent foot ulcer. Sixty diabetic ulcers patients were participating in this study during the period of the study from July 2018 to July 2021. The data was collected by using a questionnaire. The data was analyzed by using statistical package for social sciences (SPSS). The study results evident that the percentage of knowledge regarding diabetic septic foot patient to prevent foot ulcer for all items of diabetic septic foot care, were improved after the training program. The results of study regarding knowledge of patients to cause of diabetic foot ulcers were highly increased in percentages in post-intervention compared to pre-intervention. The results regarding education of risk factors of diabetic patients were increased in percentage in post-intervention compared to pre-intervention in education program for correct questions, but for incorrect it decreased also same results were presented in surgical management. The study concluded that there was significant improvement in patients’ knowledge attitude and practice regarding diabetic septic foot care after the education program. So the study recommended that continuing education program for diabetic septic foot patients is very important, learning facilities (books, Journals) about diabetic septic foot care should be available at hospitals

Background: Diabetic septic foot contributes significantly to morbidity and mortality of patients with diabetes leading to substantial physical, physiological and financial burden for the patients and community at large.Objective: to determine the prevalence, patterns and risk factors of diabetic foot ulcers amongst patients with diabetes mellitus who were attending the diabetes center of Arar city in the period of the study.Methods: This was a retrospective study in the patients of the diabetes center of Arar city, Northern Saudi Arabia.The study was carried out during the period from 1 April to 31 May, 2018.All the patients attended the diabetes center in the period of the study were included in our data.The data were collected using a predesigned questionnaire.The questionnaire covered all the necessary items in the research.Data were collected through personal interviews with the participants and filling the questionnaires.Results: The prevalence of diabetic foot among the included diabetic patients was 52.8%.77.8% had type II and 22.2% had type I, 83.3% had glucometer and 38.9% monitor their blood glucose level daily, 41.7% were obese, 77.8% had hypertension, 52.8% had hyperlipidemia.Only 11.1% examined the pulse and sensation the foot of the population.For diabetes control, 58.3% of them use oral tablets, 27.8% use insulin injection and 13.9% use both tablets and insulin but 52.8 of them have complication with treatment.Conclusion: The prevalence of diabetic foot among the included diabetic patients was high (52.8%).This emphasizes the importance of the more health education and better management of the diabetic patients in order to reduce the burden of health care costs of diabetic foot.