The Evolution and Therapeutic Potential of Polyherbal Gels and Key Botanical Extracts in Diabetic Foot Ulcer Management: A Comprehensive Narrative Review

Background: Diabetic foot ulcers (DFUs) are a devastating, multifactorial complication of diabetes mellitus characterized by neuropathy, ischemia, and chronic infection. Conventional wound care often fails to address these compounding factors, leading to high amputation rates and increasing antibiotic resistance. Objective: To systematically explore the evolution of polyherbal gels as topical interventions for DFUs (2015–2025) and comprehensively review the pharmacological evidence supporting the use of key botanical extracts: Commiphora molmol, Curcuma longa, Dragon’s Blood resin, and Propolis. Methods: A detailed literature review was conducted analyzing the transition from empirical herbal ointments to advanced polyherbal hydrogels, alongside the pharmacognosy, in vitro, in vivo, and clinical efficacy of selected natural components.Discussion: The management of DFUs has evolved toward sophisticated delivery systems, including nano-enhanced and bioinspired hydrogels. Literature confirms that extracts such as Commiphora molmol and Propolis exhibit potent antimicrobial, anti-inflammatory, and hypoglycemic properties. Curcuma longa provides significant tissue-regenerative benefits, while Dragon’s Blood resin accelerates epithelialization via targeted molecular pathways (e.g., Wnt/β-catenin, Nrf2). The integration of these botanicals offers synergistic effects that simultaneously target infection, oxidative stress, and impaired angiogenesis. Conclusion: Polyherbal gels represent a holistic, cost-effective, and resistance-minimizing paradigm in DFU management. Utilizing these synergistic natural compounds offers an evidence-based alternative to conventional treatments, particularly in resource-constrained healthcare settings.