Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2022; 13(12): 1131-1139
Published online Dec 15, 2022. doi: 10.4239/wjd.v13.i12.1131
The role of artificial intelligence technology in the care of diabetic foot ulcers: the past, the present, and the future
Joseph M Pappachan, Bill Cassidy, Cornelius James Fernandez, Vishnu Chandrabalan, Moi Hoon Yap
Joseph M Pappachan, Department of Endocrinology & Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Joseph M Pappachan, Bill Cassidy, Moi Hoon Yap, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Cornelius James Fernandez, Department of Endocrinology & Metabolism, Pilgrim Hospital, Boston PE21 9QS, United Kingdom
Vishnu Chandrabalan, Department of Data Science, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Author contributions: Pappachan JP substantially contributed to the conception and design of the article, interpretation of relevant literature, article drafting, and figure preparation; Cassidy B contributed to the interpretation of relevant literature, article drafting, and figure preparation; Fernandez CJ and Chandrabalan V contributed to the literature search and revision of the article; Yap MH supervised article preparation and revised the manuscript critically for important intellectual content; All authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Joseph M Pappachan, FRCP, MD, Consultant, Professor, Senior Editor, Senior Researcher, Department of Endocrinology & Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, United Kingdom.
Received: August 25, 2022
Peer-review started: August 25, 2022
First decision: October 30, 2022
Revised: November 1, 2022
Accepted: December 1, 2022
Article in press: December 1, 2022
Published online: December 15, 2022

Foot ulcers are common complications of diabetes mellitus and substantially increase the morbidity and mortality due to this disease. Wound care by regular monitoring of the progress of healing with clinical review of the ulcers, dressing changes, appropriate antibiotic therapy for infection and proper offloading of the ulcer are the cornerstones of the management of foot ulcers. Assessing the progress of foot ulcers can be a challenge for the clinician and patient due to logistic issues such as regular attendance in the clinic. Foot clinics are often busy and because of manpower issues, ulcer reviews can be delayed with detrimental effects on the healing as a result of a lack of appropriate and timely changes in management. Wound photographs have been historically useful to assess the progress of diabetic foot ulcers over the past few decades. Mobile phones with digital cameras have recently revolutionized the capture of foot ulcer images. Patients can send ulcer photographs to diabetes care professionals electronically for remote monitoring, largely avoiding the logistics of patient transport to clinics with a reduction on clinic pressures. Artificial intelligence-based technologies have been developed in recent years to improve this remote monitoring of diabetic foot ulcers with the use of mobile apps. This is expected to make a huge impact on diabetic foot ulcer care with further research and development of more accurate and scientific technologies in future. This clinical update review aims to compile evidence on this hot topic to empower clinicians with the latest developments in the field.

Keywords: Diabetic foot ulcers, Photographic monitoring, Artificial intelligence technology, Digital photography, Mobile app, COVID-19 pandemic

Core Tip: Diabetic foot clinics faced major challenges during the COVID-19 pandemic due to lockdowns and social distancing measures as a significant proportion of patients were unable to physically attend the clinics. This situation boosted the attempts for transition of face-to-face foot clinics to virtual clinics as in many other types of medical care during the pandemic. Monitoring of diabetic foot ulcers (DFUs) by digital photographic technology and mobile phone-based photography have revolutionized this area of clinical care in recent years and mobile apps are expected to accelerate this progress. This article reviews the past, the present and the future of artificial intelligence technology in the care of DFUs.