Clinical positioning and translational readiness of gel-based dressings for diabetic foot ulcers: a phenotype-oriented narrative review

Diabetic foot ulcers (DFUs) are heterogeneous, limb-threatening wounds shaped by variable combinations of neuropathy, mechanical loading, infection, ischemia, exudate, persistent inflammation, and impaired tissue repair. Gel-based dressings, particularly hydrogels, offer advantages in wound conformity, moisture control, local therapeutic delivery, and modulation of the wound microenvironment. Conventional hydrogels primarily donate moisture to selected dry or sloughy wounds, whereas engineered gel functions depend on formulation. However, most advanced gel systems remain at the preclinical stage, and increasing material complexity does not necessarily improve clinical usefulness. This narrative review examines gel-based DFU dressings from a phenotype-oriented clinical and translational perspective. Rather than cataloguing materials solely by polymer composition or bioactive function, we consider how gel properties may be positioned within the management of clinically recognizable wound conditions, including dry or sloughy wound beds, exudate imbalance, infection status, impaired perfusion, tissue condition, wound geometry, mechanical loading, and delayed epithelial progression. We distinguish these clinically assessable features from underlying biological targets, such as excessive oxidative stress, persistent inflammation, and impaired angiogenesis, while recognizing that overlapping wound problems require clinical prioritization and repeated assessment. We emphasize that gel dressings should be used as adjuncts to, rather than replacements for, established DFU care, including offloading, debridement, infection management, vascular assessment, revascularization when indicated, and metabolic control. Current clinical evidence for hydrogel dressings is limited and heterogeneous. Their translational value therefore depends on clinically relevant model selection, repeated-use safety, wound-like release behavior, sterilization, storage stability, manufacturing reproducibility, regulatory classification, cost, and compatibility with routine wound-care workflows. We propose an evidence-informed phenotype-oriented clinical-positioning framework and a qualitative comparison of representative gel platforms against translational-readiness criteria; the proposed framework is not a validated treatment algorithm. A relatively simple dressing with a well-defined role in the DFU care pathway may ultimately be more valuable than a highly multifunctional platform without a realistic route to clinical adoption.