For podiatrists and physicians discuss the role AI plays in foot care. Preventing diabetic foot wounds before they start is still the best way to protect patients, they say
By Jolene Cleaver
Artificial intelligence is reshaping podiatry, from diagnostic imaging and surgical planning to custom orthotics and office workflows.
While technology continues to advance, local specialists say one goal remains unchanged: Preventing diabetic foot wounds before they start is still the best way to protect patients.
Podiatry is rapidly evolving through AI-driven diagnostics, 3D-printed customized orthotics and advanced remote monitoring tools designed for proactive patient care.
Artificial intelligence has moved from an experimental tool to an increasingly important part of clinical practice, area podiatrists say.
At Mohawk Valley Health System in Utica, Daniel Herbowy, a core faculty member of the MVHS Podiatry Residency Program, sees firsthand how technology is changing patient care.
“Across the board, people are using AI more and more,” Herbowy said. “It’s changing things quite a bit.”
Artificial intelligence is being used to review X-rays and MRIs as a second reader, helping identify microfractures, joint changes and early deformities. AI platforms also evaluate clinical photographs to identify early tissue changes, allowing clinicians to predict diabetic foot ulcers before a wound develops.
Imaging technology has also changed dramatically.
“There have been advances that are so profound,” Herbowy said.
Three-dimensional imaging now allows surgeons to reconstruct damaged bones with remarkable precision. If a foot bone has been destroyed, physicians can image the opposite foot and use that information to map plans for an artificial bone. Joint replacement manufacturers also request imaging to help create replacement joints tailored to individual patients.
Traditional plaster casts are gradually being replaced with handheld 3D digital scanners and camera-based systems that create detailed maps of a patient’s foot anatomy. AI-powered biomechanical platforms analyze gait data collected from pressure plates, identifying hidden imbalances. Those digital files can then be sent directly to additive manufacturing systems to produce custom 3D-printed orthotics with improved fit and variable stiffness.
For diabetic patients, however, technology is only part of the story.
Herbowy frequently treats diabetic ulcers and wounds using advanced tissue substitutes designed to promote healing. Artificial skin substitutes made from materials including fish skin and placenta can be applied without concerns about rejection.
“They help regenerate angiogenesis or circulation,” Herbowy said. “We also employ wound vacuum systems, negative pressure therapy that takes away some of the drainage not uncommon with wounds. But also the negative pressure will result in good circulation.”
The greatest challenge for many diabetic patients is neuropathy.
Patients lose sensation in their feet and develop numbness. Diabetes also impairs the body’s ability to heal. Even something as small as a pebble inside a shoe can create a lesion because patients cannot feel the irritation.
Adjusting body position to relieve pressure is the body’s natural response to pain. Patients with diabetic neuropathy often do not have that warning system, allowing small injuries to become serious wounds that can develop into severe infections.
Herbowy encourages patients to pay attention to warning signs.
“Pain is not normal. If there’s something painful that’s nature’s way of telling you that something is wrong,” he said. “If your foot hurts, you aren’t going to want to get any steps done.”
He noted that conditions such as corns and calluses can be especially painful for patients with hypertension. Beyond wounds, podiatrists also routinely treat bunions, hammertoes and fungal infections.
“There’s a lot that we do,” Herbowy said.
In the Cobleskill-based Bassett Healthcare Network, physician Maria Begum has been treating patients since joining the organization in 2022.
Begum sees a steady stream of diabetic wound care patients, along with fractures and surgical referrals.
“The majority of our patients are diabetic,” she said. “You never get bored.”
She also sees AI improving surgical planning.
When patients require reconstructive procedures for conditions such as flatfoot deformities or bunions, AI can use CT scan results to create cutting guides for surgeons. That technology can simplify bone reconstruction in some cases while improving surgical precision.
Begum said advances over the past decade have shortened recovery times for many procedures.
Patients who once faced recoveries lasting up to 12 weeks may now be back on their feet in about four weeks. The improvements are particularly meaningful for teenagers involved in sports and other active patients eager to return to their normal routines.
“Injuries are not a jail sentence anymore,” she said.
Looking ahead, Begum believes prevention will continue to be a major focus.
One emerging treatment available in Cobleskill uses a platelet-rich plasma machine. The patient’s own platelets are processed and injected back into the wound to initiate growth factors. Medicare and Medicaid reimbursement is available for platelet-rich plasma therapy.
Research is showing it heals faster, she said.
Technology is also moving beyond the clinic.
The preventive care sector is increasingly adopting wearable technology, including smart insoles embedded with sensors that continuously monitor plantar pressure and temperature. When pressure or temperature reaches a concerning threshold, the system can automatically alert care teams, allowing intervention before a serious wound develops.
Artificial intelligence is also reducing administrative work. Ambient documentation tools can draft clinical notes during patient visits, while backend AI systems review billing codes and insurance eligibility to streamline practice operations.
Still, both physicians agree that education and prevention remain the strongest tools available.
For diabetic patients, Begum recommends checking their feet every day and inspecting shoes before putting them on.
“Check your feet every single day. Check your shoes before you put your foot inside,” she said. “A lot of times they can’t feel it and they’re walking on a pebble for days and for me it’s either a full-blown ulcer or I can see their bone. Use a mirror if you have to.”
For everyone else, she recommends wearing supportive shoes with inserts and choosing footwear with a wide toe box.
“We have to focus on prevention and education,” Begum said. “Many times people come to a podiatrist when it’s too late.”
As AI continues to reshape podiatry, physicians say the technology offers new opportunities to detect problems earlier, improve surgical outcomes and enhance wound healing. But even with rapid advances, the most effective treatment is still preventing injuries before they become life-changing complications.