From Plantar Loading to Tissue Injury: Mechanobiology and Prevention of Diabetes-Related Foot Ulceration

Diabetic foot biomechanics and mechanobiology are central to understanding how mechanical exposure leads to tissue adaptation, recoverable stress, or ulceration in people with diabetes. Diabetic foot ulceration results from interactions among plantar pressure and shear, tissue composition and stiffness, foot geometry, fat-pad integrity, neuropathy, vascular dysfunction, inflammation, and impaired tissue repair. Although elevated plantar pressure and repetitive loading are established risk factors, they do not fully explain individual differences in ulcer susceptibility. Recent advances in pressure–shear sensing, wearable monitoring, imaging, tissue characterization, and patient-specific computational modelling have enabled more comprehensive assessment of mechanical exposure and internal tissue stress. However, important gaps remain in linking measured loading to biological responses, accounting for recovery between loading events, validating model-derived quantities, and translating multidimensional measurements into reliable indicators of first-ulcer and recurrence risk. More integrated investigation is needed to clarify the mechanisms of tissue failure and support individualized prevention.This Research Topic aims to advance understanding of how the magnitude, direction, duration, repetition, and distribution of mechanical loading interact with tissue susceptibility and recovery in the diabetic foot. It will examine how biomechanical, biological, clinical, and behavioural factors contribute to tissue breakdown and healing, and how these interactions can be measured, modelled, and translated into clinical practice. Key questions include which characteristics distinguish adaptive from injurious loading; how neuropathy, perfusion, inflammation, tissue properties, and previous ulceration modify mechanical risk; and whether combined measurements can improve the prediction of first and recurrent ulceration. The Research Topic also seeks evidence supporting personalized footwear, offloading, rehabilitation, monitoring, and clinical decision-making.To gather further insights into the mechanisms, measurement, modelling, prediction, and prevention of diabetic foot tissue injury, this Research Topic will focus on studies of human diabetic foot biomechanics and related biological and clinically relevant processes. Studies should address biomechanical, mechanobiological, or tissue-level mechanisms rather than purely clinical outcomes, while recognizing the limitations of laboratory measurements, cross-sectional designs, inferred variables, and model-dependent estimates. We welcome articles addressing, but not limited to, the following themes:• Plantar pressure, shear, combined loading, and internal tissue stress and strain• Diabetes-related changes in tissue composition, stiffness, fat-pad integrity, and mechanical susceptibility• Neuropathy, perfusion, inflammation, mechanotransduction, tissue repair, and recovery between loading events• Pressure–shear sensors, wearable technologies, and real-world activity monitoring• Patient-specific, multiscale, and mechanobiological computational modelling• Experimental tissue characterization and validation of computational models• Measurement reliability, calibration, repeatability, uncertainty, and model validation• Biomarkers and multimodal indicators for predicting first and recurrent ulceration• Pre-ulcerative tissue changes, remission, recurrence, and recently healed feet• Personalized footwear, offloading, rehabilitation, and translation of measurements into clinical action• Interdisciplinary and translational approaches that distinguish measured variables from inferred or model-derived quantitiesAccepted article types: Original Research, Reviews, Systematic Reviews, Methods, and Technology and Code. Purely clinical studies and Clinical Trials are not included. Topic editors: Gurpreet Singh, David G. Armstrong, DPM, MD, PhD, Abir Dutta Source: https://www.frontiersin.org/research-topics/86920/from-plantar-loading-to-tissue-injury-mechanobiology-and-prevention-of-diabetes-related-foot-ulceration