Rehabilitation Wearable Boots and Offloading Methods for Diabetic Foot Ulcer Treatment: A Systematic Review.

Diabetic foot ulcers (DFUs) are a serious and common complication of diabetes, primarily affecting the plantar surface and toes. They are associated with high rates of recurrence, amputation and mortality, making effective treatment strategies essential. This review explores the current landscape of offloading methods and rehabilitation wearable boots used in DFU management, with an emphasis on clinical efficacy, patient adherence and the integration of emerging technologies. Total contact casts (TCCs), the gold standard, achieve healing rates exceeding 80%-90% but face limited adoption due to discomfort, stigma, and lifestyle disruption. Meta-analyses indicate that custom orthotics may reduce ulcer recurrence by up to 50% compared with standard footwear, although the magnitude of benefit varies across studies. In contrast, recent advances in smart wearable devices, multimodal sensors, custom orthotics and AI-driven adaptive systems demonstrate potential to enhance patient compliance and therapeutic outcomes. Despite the availability of evidence-based guidelines, a significant gap persists in their consistent application in clinical settings. Bridging this gap requires the development of patient-centric solutions that integrate technological innovation with usability, comfort and accessibility. This review highlights the need and future for innovative approaches that integrate technology and design to support healing, rehabilitation, adherence and quality of life providing pathways for more effective and sustainable DFU management.