For years, we’ve operated under a simple clinical assumption: if a diabetic foot ulcer (DFU) is infected, we reach for the antibiotics—often broad-spectrum heavy hitters like levofloxacin. But new molecular evidence suggests that while we are busy fighting bacteria, we may be unintentionally collateral-damaging the wound’s own healing machinery. A recent study published in Scientific Reports has uncovered a "redox paradox" where common antibiotics appear to trigger oxidative stress, potentially locking chronic wounds in a state of non-healing.

Tiny Robots, Big Gains: Is Nanobotics the Future of Limb Salvage? The "holy grail" of wound healing has always been a treatment that doesn't just sit on the wound but actively works within it. Traditional dressings—even the fancy ones—are largely passive barriers. But a groundbreaking review recently published in the International Journal of Nanomedicine suggests we are entering the era of "smart wound management" powered by micro/nanorobots.

FOR IMMEDIATE RELEASE LOS ANGELES, CA — Dr. David G. Armstrong, Distinguished Professor of Surgery and Neurological Surgery at the Keck School of Medicine of USC, has reached a historic bibliometric milestone. According to the latest data from Google Scholar, Dr. Armstrong has become the first podiatric surgeon in the history of the specialty to receive more than 10,000 citations in a single calendar year…

For decades, the standard response to a diabetic foot ulcer has been to shut everything down. We focus so intently on offloading that we often inadvertently prescribe a total sedentary lifestyle. But as our colleagues at the University of Michigan point out in their recent review, we need to shift the narrative toward "Toe, Flow, and Go"—ensuring that while we protect the wound, we don't sacrifice the patient's systemic health.

We often view lower extremity amputation (LEA) as the culmination of a rapid clinical decline, but new data suggests the warning signs are flashing nearly a decade in advance. A large 10-year national study out of Denmark recently identified specific healthcare and sociodemographic markers that can predict amputation risk long before the situation becomes "limb or life". By analyzing over…

Friends, we have some serious dogma-busting data to discuss today. For as long as most of us have been in the limb salvage game, the percutaneous bone biopsy has been preached as the absolute "Gold Standard" for guiding antibiotic therapy in Diabetic Foot Osteomyelitis (DFO). The logic was sound: if you want to know what’s killing the bone, you go to the bone.

Biofilms are the silent drivers of chronicity in diabetic foot ulcers (DFUs). We talk about them constantly. We blame them for stalled healing. But when you peel back the layers of current literature, how much hard clinical evidence do we actually have that our interventions are destroying them? In our latest systematic review, published in the International Wound Journal, we set out to map the gap between what works in a petri dish and what actually heals a patient.

We often talk about the "Princess and the Pea" in our line of work, but for our patients with neuropathy, the story is reversed. The pea—or the rock, or the seam—is there, but the princess simply cannot feel it. A fascinating new narrative review just published in J. Clin. Med. by Carral-Sota and colleagues drives this point home with what I’m calling the…

FOR IMMEDIATE RELEASE ANTALYA, TURKEY – David G. Armstrong, DPM, MD, PhD, Distinguished Professor of Surgery and Neurological Surgery at the University of Southern California (USC), has been selected to deliver the opening keynote address at the 19th National & 7th International Wound Congress. The event, held at the Titanic Mardan Palace from December 4–7, 2025, gathers global leaders to discuss the latest innovations in tissue repair and limb preservation.

For years, we’ve treated Painful Diabetic Neuropathy (PDN) largely by trying to turn down the volume on the pain. While relief is critical, the "holy grail" has always been something more: stopping the damage or, dare we dream, reversing it. We have just published the design for a new multicenter randomized controlled trial (RCT) in BMJ Open that asks an important question: Can high-frequency 10 kHz spinal cord stimulation (SCS) actually improve neurological function?

We often get asked this by patients (and some doctors). Here is a little diagram. That "red stuff" or what I call a "red carpet" at the top is the hallmark of healthy healing—clinicians often call it "beefy red" tissue. It gets that color and texture primarily because it is a dense network of new blood vessels. Here is exactly what that top layer is composed of:

Team, we often talk about the "endgame" of limb salvage—the complex surgeries, the revascularization, the high-tech grafts. But the truth? The war against amputation is usually won or lost long before a patient ever sees a surgeon. It’s won in the primary care office. Our latest paper, just out in the Journal of Diabetes and its Complications, isn't about the newest surgical robot.

Important nationwide data coming out of Australia from our friend Jonathan Shaw and the team. We often talk about the burden of diabetes, but this study puts a hard number on the "time toxicity" of hospitalization. The Bed-Day Burden Let’s look at the raw numbers. People with diabetes are racking up massive excess time in the hospital compared to the general population:

Treating Diabetic Foot Osteomyelitis (DFO) in the forefoot is a daily battle in the trenches of limb preservation. It is the most common location for DFU, DFI, and DFO, occurring in up to 90% of cases. While we often lean on conservative standard care, it frequently fails when the bone is involved. Our colleagues in Lebanon, led by Dr. Kaissar Yammine, have just released a preliminary report that hits the sweet spot between aggressive resection and functional preservation.

By: David G. Armstrong, DPM, MD, PhD We often discuss frailty as a geriatric syndrome—something to worry about when our patients reach their 70s or 80s. However, new data suggests we are missing a massive "middle" demographic that is silently struggling. This likely affects our efforts on a daily basis. In a fascinating new article in press, Bilici and Kılıç shed light on a critical blind spot in our preventative care strategies: the "frail" middle-aged patient.

FOR IMMEDIATE RELEASE LOS ANGELES – The work of David G. Armstrong, DPM, MD, PhD, and the Southwestern Academic Limb Salvage Alliance (SALSA) has crossed a significant bibliometric threshold, surpassing 90,000 citations in peer-reviewed literature. According to Google Scholar, Professor Armstrong’s research now holds an h-index of 133 and an i10-index of 549, reflecting the profound and widening impact of the "Toe and Flow" team approach to eliminating preventable amputations.

Understanding the Vascular Dynamics of DFU Healing and Pathology A recent study published in the Journal of Clinical Medicine by Christensen et al. (2025) utilized Oxygen-15 Labeled Water PET imaging to investigate resting skeletal muscle perfusion in patients with Type 2 Diabetes Mellitus (T2DM) and diabetic foot ulcers (DFUs), comparing them to healthy controls. This advanced imaging technique offers new insights into how blood flow changes in the presence of an active DFU.

A persistent question in the management of infected diabetic foot ulcers (DFUs) is deceptively simple: Does it matter whether we swab or take tissue? Guidelines emphasize tissue sampling, yet swabbing is easier, cheaper, and far more widely used. The CODIFI2 randomized controlled trial, published in Health Technology Assessment (2025), offers timely insight — though, as the authors acknowledge, not definitive answers.

I Reflections on new work from the International Flow and Toe Research Team (iFORT) One of the most persistent challenges in limb preservation is not the first ulcer — it is the next one. Recurrence remains a defining feature of the disease, with up to 60% of people developing a new ulcer within three years of “healing.” This cycle drives avoidable hospitalizations, infections, and amputations, and it underscores the need for tools that help clinicians identify biological risk…