Wearable Technologies for Diabetic Foot Ulcer Monitoring and Risk Prediction: Systematic Review

Abstract

Abstract Background Wearable technologies, including smart insoles and sensor-equipped footwear, enable continuous monitoring of key foot parameters such as plantar pressure and temperature in individuals at risk of diabetic foot ulcers (DFUs). Objective This systematic review aimed to evaluate the technological characteristics and clinical applications of wearable devices for monitoring DFU-related parameters. Methods This review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Journal articles, theses, and dissertations evaluating wearable technologies for DFU prevention or monitoring were eligible if they involved human participants and were published in English or Persian. Studies focused on nonwearable or non-foot–based systems were excluded. A comprehensive search was conducted in PubMed, Embase, Web of Science, and Scopus from July 2024 to May 2025. Two reviewers (HE and SS) independently screened studies and extracted data. The methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) 2018. Results were synthesized using descriptive synthesis. Results A total of 1088 records were identified, of which 23 studies met the inclusion criteria. The included studies varied in design, sample size, and follow-up duration. Wearable devices included smart insoles, socks, and external sensors, primarily monitoring plantar pressure and temperature. Devices differed in sensor type, placement, number, communication protocols, and data acquisition rates. Participants typically had diabetes, and many had a history of neuropathy or prior DFUs. Conclusions Wearable technologies show promise for monitoring DFU risk factors and supporting early detection. However, the evidence base is limited by heterogeneity in study designs, small sample sizes, and short follow-up periods. Further high-quality studies are required to evaluate their potential clinical benefits, long-term outcomes, and role in preventing DFUs and improving patient care.