Hydrogel dressings for diabetic foot ulcers: microenvironment-informed design, clinical scenario matching, and translational challenges.

Diabetic foot ulcers (DFUs) are difficult-to-heal chronic wounds characterized by ischemia, biofilm-associated infection, persistent inflammation, oxidative stress, protease-rich exudate, and abnormal biomechanics. Although hydrogel dressings have been widely explored for DFU management, many reviews remain material-centered and provide limited guidance on clinical scenario matching. This review proposes a microenvironment-informed framework for DFU hydrogel design. We organize hydrogel strategies according to dominant pathological barriers, including impaired angiogenesis, chronic inflammation, oxidative injury, infection, and complex wound geometry, and compare topical/coating, injectable, patch/membrane, microneedle, and 3D-printed systems according to their clinical suitability. Preclinical evidence is synthesized by therapeutic function, while translational barriers such as model heterogeneity, sterilization, batch variability, regulatory classification, and health-economic evidence are critically examined. Pathology-guided bioactivity combined with scenario-matched formulation design may help reposition hydrogel dressings from laboratory constructs toward practical adjuncts in multidisciplinary DFU care.