Next Generation Footwear for Diabetic Neuropathy: A Narrative Review on Biomechanical Innovations and Smart Technologies for Ulcer Prevention

Diabetic Neuropathy (DN) significantly alters foot biomechanics, leading to abnormal pressure distribution, impaired gait patterns, and a heightened risk of foot ulcers, which often precede lower-limb amputations. Traditional diabetic footwear focuses on static pressure relief but lacks real-time adaptability to biomechanical changes. Recent advancements in smart sensor technology, Artificial Intelligence (AI), and 3D printing offer a dynamic approach to ulcer prevention and mobility enhancement. This narrative review explores emerging innovations in diabetic footwear that integrate biomechanical adaptations and smart technologies to optimise pressure redistribution, improve gait stability, and reduce ulcer risk in individuals with DN. A comprehensive literature review was conducted using PubMed, SCOPUS, Web of Science, and PEDro databases. Studies focusing on pressure-sensing insoles, AI-assisted gait analysis, thermal ulcer detection, and 3D-printed orthotics were analysed. The impact of these technology on plantar pressure offloading, gait mechanics, and ulcer prevention was evaluated. Recent findings indicate that smart footwear incorporating pressure sensors can reduce peak plantar pressures by up to 35%, thereby significantly lowering the risk of ulcer formation. AI-driven wearable technologies enables early detection of abnormal gait patterns, allowing real-time interventions to help prevent diabetic foot complications. Additionally, 3D-printed footwear offers personalised pressure redistribution, surpassing traditional diabetic shoes in providing customised foot support. Integrating biomechanical principles with sensor technology shows considerable potential for improving mobility and foot health in diabetic patients. Future research should focus on large-scale clinical trials, cost-effectiveness, and practical implementation to ensure widespread accessibility in diabetic foot care.