Meta-Analysis on Medical and Surgical Management of Diabetic Foot

Abstract

Background: Diabetic foot syndrome (DFS) is a multifactorial complication of diabetes driven by neuropathy, ischemia, infection, and impaired wound repair, and remains a major cause of non-traumatic lower-limb amputation. Objective: To synthesize evidence on the effectiveness of medical and surgical strategies for DFS management, focusing on ulcer healing, recurrence, microcirculatory outcomes, and limb salvage. Methods: A systematic review and meta-analysis was conducted using PubMed, Scopus, Web of Science, ScienceDirect, and Google Scholar. Records were screened and full texts assessed for eligibility. Comparative clinical studies in adults with DFS/diabetic foot ulcers evaluating medical optimization, wound care modalities, surgical correction/offloading, or revascularization were included. Results: A total of 876 records were identified; after duplicate removal, 770 records were screened and 258 full texts were assessed. Ninety-four studies were included in qualitative synthesis and 58 contributed to quantitative synthesis. Pooled analyses supported favorable associations for glycemic optimization (RR 0.72, 95% CI 0.63–0.82; I² 48%) and debridement-based wound care (RR 1.35, 95% CI 1.18–1.54; I² 52%). Corrective osteotomy was associated with lower recurrence (OR 0.28, 95% CI 0.14–0.55; I² 44%), and revascularization improved limb salvage (RR 1.42, 95% CI 1.19–1.69; I² 61%). Conclusion: Integrated medical optimization, structured wound care, and selected surgical and vascular interventions are associated with improved DFS outcomes, though heterogeneity suggests patient-phenotype–guided treatment selection is essential.