The diabetic foot remains a major cause of morbidity worldwide. Even though considerable progress has been
achieved over the past years, there is still an urgent need for improvement. While established therapeutic modalities (revascularization,
casting and debridement) remain the mainstay of management, there is, therefore, continuous development
of new treatment options. This review provides an outlook of advances in topical treatment, including bioengineered
skin substitutes (such as Dermagraft, Apligraf, HYAFF, OASIS and Graftjacket), extracellular matrix proteins (such as
Hyalofill and E-matrix), as well as miscellaneous further therapeutic adjuncts. Although promising, new therapies should
not, for the time being, constitute the basis of management, since clinical experience has not yet confirmed their effectiveness
in hard-to-heal diabetic foot ulcers. Furthermore, their cost-effectiveness merits further investigation. Instead, they
should only be considered in combination with established treatments or be attempted when these have not been successful.
Moreover, we should not be oblivious to the fact that established and emerging treatments need to be practised in the
setting of multidisciplinary foot clinics to reduce the number of amputations.