Treating the whole not the hole: necessary coupling of technologies for diabetic foot ulcer treatment

•Diabetic foot ulcers (DFUs) are a major complication of diabetes.•We describe the development of next-generation technologies for DFU repair.•We highlight the modest success of growth factor-, scaffold-, and cell-based DFU therapies.•We rationalize that combination therapies will be necessary to enable effective and reliable DFU repair.

Type 2 diabetes is the epidemic of our generation, and diabetic foot ulcers (DFUs) are a major complication. Although DFU formation itself can indicate disease progression, the failure to effectively treat ulcers contributes further to a decay in patient quality of life and increased mortality. Herein we discuss the development of next-generation DFU therapies including: (i) topical growth factors, (ii) scaffolds, and (iii) cellular therapies. Individually these therapies have yielded measurable but modest improvements in DFU repair. Because DFUs arise as a result of multiple biochemical deficiencies, a singular treatment modality is unlikely to be effective. Next-generation DFU technologies must be combined to address effectively the complex underlying pathology and enable reliable DFU repair.