Journal of Yeungnam Medical Science

Focused Review articles

Orthopedics and Sports Medicine
State-of-the-art update for diagnosing diabetic foot osteomyelitis: a narrative review: Inha Woo, Seung Jae Cho, Chul Hyun Park; J Yeungnam Med Sci. 2023;40(4):321-327. Published online October 12, 2023; DOI: https://doi.org/10.12701/jyms.2023.00976

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Recently, the International Working Group on the Diabetic Foot and the Infectious Diseases Society of America divided diabetic foot disease into diabetic foot infection (DFI) and diabetic foot osteomyelitis (DFO). DFI is usually diagnosed clinically, while numerous methods exist to diagnose DFO. In this narrative review, the authors aim to summarize the updated data on the diagnosis of DFO. An extensive literature search using “diabetic foot [MeSH]” and “osteomyelitis [MeSH]” or “diagnosis” was performed using PubMed and Google Scholar in July 2023. The possibility of DFO is based on inflammatory clinical signs, including the probe-to-bone (PTB) test. Elevated inflammatory biochemical markers, especially erythrocyte sedimentation rate, are beneficial. Distinguishing abnormal findings of plain radiographs is also a first-line approach. Moreover, sophisticated modalities, including magnetic resonance imaging and nuclear medicine imaging, are helpful if doubt remains after a first-line diagnosis. Transcutaneous bone biopsy, which does not pass through the wound, is necessary to avoid contaminating the sample. This review focuses on the current diagnostic techniques for DFOs with an emphasis on the updates. To obtain the correct therapeutic results, selecting a proper option is necessary. Based on these numerous diagnosis modalities and indications, the proper choice of diagnostic tool can have favorable treatment outcomes.

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Evaluasi Temuan Radiologi Foto Polos Pedis dextra pada Pasien dengan Osteomielitis di Instalasi Radiologi Rumah Sakit Siloam Sriwijaya Palembang
Danda Wibowo, Harry Wahyudhy, Zanariah
JURNAL LENTERA ILMIAH KESEHATAN.2026; 4(1): 8. CrossRef
Deep learning-enhanced MRI for diabetic foot tarsal bone lesions and insulin injection behavior analysis
Haidong Ye, Fang Yao
Journal of Radiation Research and Applied Sciences.2025; 18(2): 101493. CrossRef
Unveiling the challenges of diabetic foot infections: diagnosis, pathogenesis, treatment, and rehabilitation
Chul Hyun Park
Journal of Yeungnam Medical Science.2023; 40(4): 319. CrossRef

Orthopedics and Sports Medicine
The pathophysiology of diabetic foot: a narrative review: Jiyoun Kim; J Yeungnam Med Sci. 2023;40(4):328-334. Published online October 5, 2023; DOI: https://doi.org/10.12701/jyms.2023.00731

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Abstract PDF

An aging population and changes in dietary habits have increased the incidence of diabetes, resulting in complications such as diabetic foot ulcers (DFUs). DFUs can lead to serious disabilities, substantial reductions in patient quality of life, and high financial costs for society. By understanding the etiology and pathophysiology of DFUs, their occurrence can be prevented and managed more effectively. The pathophysiology of DFUs involves metabolic dysfunction, diabetic immunopathy, diabetic neuropathy, and angiopathy. The processes by which hyperglycemia causes peripheral nerve damage are related to adenosine triphosphate deficiency, the polyol pathway, oxidative stress, protein kinase C activity, and proinflammatory processes. In the context of hyperglycemia, the suppression of endothelial nitric oxide production leads to microcirculation atherosclerosis, heightened inflammation, and abnormal intimal growth. Diabetic neuropathy involves sensory, motor, and autonomic neuropathies. The interaction between these neuropathies forms a callus that leads to subcutaneous hemorrhage and skin ulcers. Hyperglycemia causes peripheral vascular changes that result in endothelial cell dysfunction and decreased vasodilator secretion, leading to ischemia. The interplay among these four preceding pathophysiological factors fosters the development and progression of infections in individuals with diabetes. Charcot neuroarthropathy is a chronic and progressive degenerative arthropathy characterized by heightened blood flow, increased calcium dissolution, and repeated minor trauma to insensate joints. Directly and comprehensively addressing the pathogenesis of DFUs could pave the way for the development of innovative treatment approaches with the potential to avoid the most serious complications, including major amputations.

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An off-the-shelf bioactive EV delivering cryogel orchestrating immunomodulatory reprogramming and angiogenesis for diabetic ulcer healing
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Responsive to adaptive supramolecular hydrogels for diabetic wound treatment
Shalini Balakrishnan, Revathy Remesh, Krishnan Kartha Kalathil, Anie Y
Supramolecular Materials.2025; 4: 100081. CrossRef
Nanotechnology-enabled approaches for combating diabetic foot ulcer
Padakanti Sandeep Chary, Anuradha Urati, Samia Shaikh, Rati Yadav, Valmala Bhavana, Naveen Rajana, Neelesh Kumar Mehra
Journal of Drug Delivery Science and Technology.2025; 105: 106593. CrossRef
Natural products in the treatment of diabetic foot infection
Mohsen Nazari, Leili Shokoohizadeh, Mohammad Taheri
European Journal of Medical Research.2025;[Epub] CrossRef
Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management
Kehkashan Parveen, Malik Asif Hussain, Sadaf Anwar, Halima Mustafa Elagib, Mohd Adnan Kausar
World Journal of Diabetes.2025;[Epub] CrossRef
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Antioxidants improve the viability of diabetic bone marrow MSCs without rescuing their pro-regenerative secretome function
Michelle Maartens, Mare Vlok, Mari van de Vyver
Molecular and Cellular Endocrinology.2025; 601: 112519. CrossRef
Risk Factors Associated with Diabetic Foot Ulcers: A Multivariate Analysis
Ajeet Saoji, Nitesh Upadhyay, Prachi Saoji, Kartik Khurana
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Bacteriological profile of diabetic foot ulcers and analysis of serum meteorin levels
Esra Erdogan, Azize Yetisgen, Lezzan Keskin, Elif Seren Tanriverdi, Isilay Gokce Benk Ugur
Molecular Biology Reports.2025;[Epub] CrossRef
DİABETİK ANGİOPATİYALARIN ULTRASƏS DOPLEROQRAFİYASI İLƏ QİYMƏTLƏNDİRİLMƏSİ
G.S. Əliyeva, C.T. Əliyeva, A.T. Bədəlova
Azerbaijan Medical Journal.2025; (1): 150. CrossRef
DFU-FuzzyLiteUNet: A lightweight u-net with Fuzzy sigmoid and lite transformer for diabetic foot ulcer segmentation
Purwono Purwono, Yessica Nataliani, Hindriyanto Dwi Purnomo, Ivanna K. Timotius
Biomedical Signal Processing and Control.2025; 108: 107902. CrossRef
Outcome of diabetic foot ulcers at a Tertiary Care Foot Centre in Pakistan
Zahid Miyan, Arwa Hatim, Saniya Khakwani, Khalid Abdul Basit
International Wound Journal.2025;[Epub] CrossRef
Diabetic Foot Ulcers: Pathophysiology, Immune Dysregulation, and Emerging Therapeutic Strategies
John Dawi, Kevin Tumanyan, Kirakos Tomas, Yura Misakyan, Areg Gargaloyan, Edgar Gonzalez, Mary Hammi, Serly Tomas, Vishwanath Venketaraman
Biomedicines.2025; 13(5): 1076. CrossRef
Adipose-derived Stem Cells for Treatment of Diabetic Foot Ulcers: A Review
Prithiviraj Nagarajan, Rajalaksmi Prithiviraj, Sharangouda J. Patil, Suresh Babu Naidu Krishna, Vasanthrie Naidoo
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BME Horizon.2025;[Epub] CrossRef
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Epigenetics and diabetic wound healing: Wilms tumor 1-associated protein as a therapeutic target
Ashraf Al Madhoun
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Synergistic Effect of Prolonged Oxygenation and Reactive Oxygen Species Scavenging on Diabetic Wound Healing Using an Injectable Thermoresponsive Hydrogel
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After the Foot has Healed
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Unveiling the challenges of diabetic foot infections: diagnosis, pathogenesis, treatment, and rehabilitation
Chul Hyun Park
Journal of Yeungnam Medical Science.2023; 40(4): 319. CrossRef

Orthopedics and Sports Medicine
Management of diabetic foot ulcers: a narrative review: Jahyung Kim, Otgonsaikhan Nomkhondorj, Chi Young An, Ye Chan Choi, Jaeho Cho; J Yeungnam Med Sci. 2023;40(4):335-342. Published online September 22, 2023; DOI: https://doi.org/10.12701/jyms.2023.00682

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Abstract PDF

Diabetic foot ulcers (DFUs) are among the most serious complications of diabetes and are a source of reduced quality of life and financial burden for the people involved. For effective DFU management, an evidence-based treatment strategy that considers the patient's clinical context and wound condition is required. This treatment strategy should include conventional practices (surgical debridement, antibiotics, vascular assessment, offloading, and amputation) coordinated by interdisciplinary DFU experts. In addition, several adjuvant therapies can be considered for nonhealing wounds. In this narrative review, we aim to highlight the current trends in DFU management and review the up-to-date guidelines.

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Clinical Efficacy of Type I Collagen Skin Substitutes Versus Human Amnion/Chorion in Treating Diabetic Foot Ulcers Using 55 Patient Randomized Controlled Independent Two Trials, One in India and the Other in the USA
Subramanian Gunasekaran
Biomedical Materials & Devices.2026; 4(1): 97. CrossRef
Advanced strategies for the management of patients with diabetic foot ulcers: a comprehensive review
Ji Min Kim, Chong Hwa Kim, Seon Mee Kang, Jung Hwa Jung, Ki Chun Kim, Sanghyun Ahn, Tae Sun Park, Ie Byung Park
The Korean Journal of Internal Medicine.2026; 41(1): 47. CrossRef
Thermosensitive chitosan hydrogel encapsulating exosomes inhibits NLRP3 activation to promote diabetic foot ulcer healing
Xinnan Song, Chenglin Sun, Fei Meng, Xiaohong Zhang, Lixin Yang
Materials & Design.2026; 263: 115561. CrossRef
Galectins: Role and Therapeutics in Diabetes and Diabetic Foot Ulcers
Alhasan Alobaidi, Rawan Al Judeid, Vikrant Rai
Biomolecules.2026; 16(2): 232. CrossRef
A feature explainability-based deep learning technique for diabetic foot ulcer identification
Pramod Singh Rathore, Abhishek Kumar, Amita Nandal, Arvind Dhaka, Arpit Kumar Sharma
Scientific Reports.2025;[Epub] CrossRef
The hidden impact: frailty and malnutrition in patients with diabetic foot ulcers
Levent Demir, Mustafa Avcı, Murat Kahraman, Selahattin Kılıç
Journal of Health Sciences and Medicine.2025; 8(2): 262. CrossRef
From Control to Cure: Insights into the Synergy of Glycemic and Antibiotic Management in Modulating the Severity and Outcomes of Diabetic Foot Ulcers
Idris Ajibola Omotosho, Noorasyikin Shamsuddin, Hasniza Zaman Huri, Wei Lim Chong, Inayat Ur Rehman
International Journal of Molecular Sciences.2025; 26(14): 6909. CrossRef
Mango ginger-derived exosome-like nanovesicles promotes diabetic wound healing via inducing the promigratory protein, follistatin-like 1.
Anaghapriya Suresh, Jahnavi Ravilla, Janakiraman Narayanan, Gopinath M. Sundaram
International Journal of Biological Macromolecules.2025; 322: 146991. CrossRef
Hydroxytyrosol from Olive Oil Mitigates Endothelial Dysfunction in Diabetic Foot Ulcers via Redox, Inflammatory, and Survival Pathways
Dhayalan Kalavathy GokulRaj, Ravichandran Jayasuriya, Kunka Mohanram Ramkumar
The Journal of Nutrition.2025; 155(12): 4149. CrossRef
Current therapeutic strategies in the management of diabetic foot ulcers
Aniket Gupta, Rishabh Chalotra, Kajal Sharma, Anjali Gupta, Shivani Chib, Rohini Agrawal, Thakur Gurjeet Singh, Randhir Singh
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Sequence analysis of microbiota in clinical human cases with diabetic foot ulcers from China
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Unveiling the challenges of diabetic foot infections: diagnosis, pathogenesis, treatment, and rehabilitation
Chul Hyun Park
Journal of Yeungnam Medical Science.2023; 40(4): 319. CrossRef

Endocrinology, Diabetes, and Metabolism
Management and rehabilitation of moderate-to-severe diabetic foot infection: a narrative review: Chi Young An, Seung Lim Baek, Dong-Il Chun; J Yeungnam Med Sci. 2023;40(4):343-351. Published online September 19, 2023; DOI: https://doi.org/10.12701/jyms.2023.00717

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Abstract PDF

Diabetic foot is one of the most devastating consequences of diabetes, resulting in amputation and possibly death. Therefore, early detection and vigorous treatment of infections in patients with diabetic foot are critical. This review seeks to provide guidelines for the therapy and rehabilitation of patients with moderate-to-severe diabetic foot. If a diabetic foot infection is suspected, bacterial cultures should be initially obtained. Numerous imaging studies can be used to identify diabetic foot, and recent research has shown that white blood cell single-photon emission computed tomography/computed tomography has comparable diagnostic specificity and sensitivity to magnetic resonance imaging. Surgery is performed when a diabetic foot ulcer is deep and is accompanied by bone and soft tissue infections. Patients should be taught preoperative rehabilitation before undergoing stressful surgery. During surgical procedures, it is critical to remove all necrotic tissue and drain the inflammatory area. It is critical to treat wounds with suitable dressings after surgery. Wet dressings promote the formation of granulation tissues and new blood vessels. Walking should begin as soon as the patient’s general condition allows it, regardless of the wound status or prior walking capacity. Adequate treatment of comorbidities, including hypertension and dyslipidemia, and smoking cessation are necessary. Additionally, broad-spectrum antibiotics are required to treat diabetic foot infections.

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Therapeutic options and prognostic risk factors in diabetic foot osteomyelitis: a narrative review
Zi-Xian Liu, Mou-Zhang Huang, Ming-Cong Ding, Xin-Ping Ma, Nan Jiang
International Journal of Surgery.2026; 112(2): 4799. CrossRef
Unveiling the challenges of diabetic foot infections: diagnosis, pathogenesis, treatment, and rehabilitation
Chul Hyun Park
Journal of Yeungnam Medical Science.2023; 40(4): 319. CrossRef

Original article

Endocrinology, Diabetes, and Metabolism
Risk factors affecting amputation in diabetic foot: Jun Ho Lee, Ji Sung Yoon, Hyoung Woo Lee, Kyu Chang Won, Jun Sung Moon, Seung Min Chung, Yin Young Lee; Yeungnam Univ J Med. 2020;37(4):314-320. Published online May 6, 2020; DOI: https://doi.org/10.12701/yujm.2020.00129

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Abstract PDF

Background
A diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU).
Methods
The study was conducted on 351 patients with DFUs from January 2010 to December 2018. Their demographic characteristics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer sizes were considered as variables to predict outcome. A chi-square test and multivariate logistic regression analysis were performed to test the relationship of the data gathered. Additionally, the subjects were divided into two groups based on their amputation surgery.
Results
Out of the 351 subjects, 170 required LEA. The mean age of the subjects was 61 years and the mean duration of diabetes was 15 years; there was no significant difference between the two groups in terms of these averages. Osteomyelitis (hazard ratio [HR], 6.164; 95% confidence interval [CI], 3.561−10.671), lesion on percutaneous transluminal angioplasty (HR, 2.494; 95% CI, 1.087−5.721), estimated glomerular filtration rate (eGFR; HR, 0.99; 95% CI, 0.981−0.999), ulcer size (HR, 1.247; 95% CI, 1.107−1.405), and forefoot ulcer location (HR, 2.475; 95% CI, 0.224−0.73) were associated with risk of amputation.
Conclusion
Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients. Further investigation would contribute to the establishment of a diabetic foot risk stratification system for Koreans, allowing for optimal individualized treatment.

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The International Journal of Lower Extremity Wounds.2024; 23(1): 70. CrossRef
Classification of foot ulcers in people with diabetes: A systematic review
Matilde Monteiro‐Soares, Emma J. Hamilton, David A. Russell, Gulapar Srisawasdi, Edward J. Boyko, Joseph L. Mills, William Jeffcoate, Fran Game
Diabetes/Metabolism Research and Reviews.2024;[Epub] CrossRef
Atherogenic markers and 1-year amputation risk in adults with diabetic foot in a tertiary level hospital: A retrospective cohort study
Jerry K. Benites-Meza, Jussara Malo-Castillo, Percy Herrera-Añazco, Vicente A. Benites-Zapata
Journal of Diabetes and its Complications.2024; 38(9): 108810. CrossRef
Lower extremity amputation rates in patients with chronic kidney disease: A database study comparing patients with and without diabetes mellitus
Dhruv Nandakumar, Matthew J. Johnson, Lawrence A. Lavery, Benjamin M. Conover, Katherine M. Raspovic, David H. Truong, Dane K. Wukich
Journal of Diabetes and its Complications.2024; 38(11): 108876. CrossRef
Analysis of clinical characteristics in patients with diabetic foot ulcers undergoing amputation and establishment of a nomogram prediction model
Tiantian Xu, Lianqi Hu, Banglin Xie, Gendong Huang, Xiaolong Yu, Fengbo Mo, Wei Li, Meisong Zhu
Scientific Reports.2024;[Epub] CrossRef
Survival rate of diabetic-related lower extremity amputees in hospitals in the Eastern Cape
Aviwe S. Mgibantaka, Alfred Musekiwa, Moleen Zunza
African Journal of Disability.2024;[Epub] CrossRef
Renal function is highly associated with podiatric risk in diabetic patients
Jean-Baptiste Bonnet, Ilan Szwarc, Antoine Avignon, Sébastien Jugant, Ariane Sultan
Clinical Kidney Journal.2023; 16(11): 2156. CrossRef
Risk factor analysis for diabetic foot ulcer‐related amputation including Controlling Nutritional Status score and neutrophil‐to‐lymphocyte ratio
Yandan Zhu, Hongtao Xu, Yuzhen Wang, Xia Feng, Xinyu Liang, Liying Xu, Zhiqiang Liang, Zhongjia Xu, Yawen Li, Yi Le, Manchen Zhao, Jianfei Yang, Ji Li, Yemin Cao
International Wound Journal.2023; 20(10): 4050. CrossRef
The association between estimated glomerular filtration rate and prognosis in patients with diabetic foot osteomyelitis
Jinghang Zhang, Dong Chen, Xuemei Li, Min Ding, Jun Xu, Meijun Wang, Bai Chang
International Wound Journal.2022; 19(7): 1650. CrossRef
Renal Function Status in Patients with Diabetes Mellitus Having Diabetic Foot Infection and Role of Antibiotics
Shabab Hussain, . Arrham, Syeda Javeriya Saeed, Ahmad Murtaza Anwar, Asif Khan, Saifullah Brohi
Pakistan Journal of Health Sciences.2022; : 189. CrossRef
Re-understanding and focusing on normoalbuminuric diabetic kidney disease
Na An, Bi-tao Wu, Yu-wei Yang, Zheng-hong Huang, Jia-fu Feng
Frontiers in Endocrinology.2022;[Epub] CrossRef
The effects of curcumin intake on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double‐blind, placebo‐controlled trial
Mehrdad Mokhtari, Reza Razzaghi, Mansooreh Momen‐Heravi
Phytotherapy Research.2021; 35(4): 2099. CrossRef
Prevalence of Sarcopenia and Its Association With Diabetes: A Meta-Analysis of Community-Dwelling Asian Population
Seung Min Chung, Jun Sung Moon, Min Cheol Chang
Frontiers in Medicine.2021;[Epub] CrossRef
Clinical outcomes among patients with chronic kidney disease hospitalized with diabetic foot disorders: A nationwide retrospective study
Michael Salim
Endocrinology, Diabetes & Metabolism.2021;[Epub] CrossRef
Diabetic foot infections: Profile and antibiotic susceptibility patterns of bacterial isolates in a tertiary care hospital of Oman
Mohan Bilikallahalli Sannathimmappa, Vinod Nambiar, Rajeev Aravindakshan, Mohammad Saleem Jawad Al Khabori, Asma Hamed Sulaiman Al-Flaiti, Kadhiya Nasser Mohamed Al-Azri, Ali Khamis Saif Al-Reesi, Alya Rashid Mohammad Al Kiyumi
Journal of Education and Health Promotion.2021;[Epub] CrossRef

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