A Narrative Review of Clinical Decision Support Systems in Offloading Footwear for Diabetes-Related Foot Ulcers

• URL: http://arxiv.org/abs/2509.02923v1
• Date: Wed, 03 Sep 2025 01:22:34 GMT
• Title: A Narrative Review of Clinical Decision Support Systems in Offloading Footwear for Diabetes-Related Foot Ulcers
• Authors: Kunal Kumar, Muhammad Ashad Kabir, Luke Donnan, Sayed Ahmed,
• Abstract summary: Offloading footwear helps prevent and treat diabetic foot ulcers (DFUs) by lowering plantar pressure (PP)<n>Guidelines emphasize PP thresholds but rarely yield actionable, feature-level outputs.<n>Machine-learning work introduces predictive, optimization, and generative models with high computational accuracy but limited explainability and clinical validation.<n>We propose a five-part CDSS framework: (1) a minimum viable dataset; (2) a hybrid architecture combining rules, optimization, and explainable ML; (3) structured feature-level outputs; (4) continuous validation and evaluation; and (5) integration with clinical and telehealth datasets.
• Score: 0.5413132875192254
• License: http://creativecommons.org/licenses/by/4.0/
• Abstract: Offloading footwear helps prevent and treat diabetic foot ulcers (DFUs) by lowering plantar pressure (PP), yet prescription decisions remain fragmented: feature selection varies, personalization is limited, and evaluation practices differ. We performed a narrative review of 45 studies (12 guidelines/protocols, 25 knowledge-based systems, 8 machine-learning applications) published to Aug 2025. We thematically analyzed knowledge type, decision logic, evaluation methods, and enabling technologies. Guidelines emphasize PP thresholds (<=200 kPa or >=25--30\% reduction) but rarely yield actionable, feature-level outputs. Knowledge-based systems use rule- and sensor-driven logic, integrating PP monitoring, adherence tracking, and usability testing. ML work introduces predictive, optimization, and generative models with high computational accuracy but limited explainability and clinical validation. Evaluation remains fragmented: protocols prioritize biomechanical tests; knowledge-based systems assess usability/adherence; ML studies focus on technical accuracy with weak linkage to long-term outcomes. From this synthesis we propose a five-part CDSS framework: (1) a minimum viable dataset; (2) a hybrid architecture combining rules, optimization, and explainable ML; (3) structured feature-level outputs; (4) continuous validation and evaluation; and (5) integration with clinical and telehealth workflows. This framework aims to enable scalable, patient-centered CDSSs for DFU care; prioritizing interoperable datasets, explainable models, and outcome-focused evaluation will be key to clinical adoption.

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