Volume: 46 Issue: 3
Year: 2026, Page: 163-170, Doi: https://doi.org/10.51248/v46i3.53
Received: May 5, 2026 Accepted: Oct. 1, 2026 Published: Oct. 2, 2026
Background: Diabetic foot ulcers (DFUs) are among the most serious complications of diabetes mellitus, affecting up to one-third of patients during their lifetime. They are a leading cause of hospitalization, infection, and lower-limb amputation. Emerging evidence suggests that vitamin D deficiency may contribute to impaired wound healing, vascular dysfunction, and immune dysregulation in DFU patients. Objective: This systematic review evaluates the role of vitamin D in the prevention and management of DFUs, with emphasis on its pathophysiological mechanisms, clinical associations, and therapeutic potential. Methods: A comprehensive search was conducted across PubMed, Scopus, Springer, ADA, NIH, and other databases without language or year restrictions. Studies examining the correlation between vitamin D levels and DFUs, as well as interventional trials assessing supplementation, were included. Case reports, editorials, and animal studies were excluded. The available study-selection information was organized using a PRISMA-style flow diagram. Results: Evidence consistently demonstrates that DFU patients exhibit significantly lower serum vitamin D levels compared to controls. Meta-analyses confirm associations between deficiency and peripheral arterial disease, neuropathy, and delayed wound healing. Randomized controlled trials further support its role in improving glycaemic control and wound healing outcomes. Thus, supplementation is a potentially useful adjunct in patients with documented deficiency, but evidence is insufficient to establish vitamin D as a stand-alone DFU treatment. Conclusion: Vitamin D deficiency is a modifiable risk factor in DFU pathogenesis. Supplementation appears to improve healing, reduce complications, and strengthen immune responses. Future large-scale randomized trials are warranted to establish standardized protocols for vitamin D use in DFU management.
Keywords: Diabetic foot ulcer (DFU), Vitamin D deficiency, wound healing, peripheral arterial disease, Supplementation
1. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017 and 376(24):2367-75. • Medline:
2. International Diabetes Federation. IDF Diabetes Atlas, 10th ed. Brussels: IDF; 2021. Available from www.diabetesatlas.org
3. Holick MF. Vitamin D deficiency. N Engl J Med. 2007:357(3):266-81.
4. Norman AW. From vitamin D to hormone D: fundamentals of the vitamin D endocrine system. Endocr Rev. 2008;29(2):141–50.
5. Boulton AJM, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366(9498):1719–24.
6. Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: Harris MI, Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennett PH, editors. Diabetes in America. 2nd ed. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases.
7. Apelqvist J, Larsson J. What is the most effective way to reduce incidence of diabetic foot ulcers? Diabetes Metab Res Rev. 2000; 1):S75-S83, 16(Suppl). DOI: 10.1002/1520-7560(200009/10)16:1+S75
8. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003; 361(9368):1545–51. DOI: 10.1016/S0140-6736(03)13169-8.
9. Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot
ulceration. Ann Med. 2017;49(2):106–16. DOI: 10.1080/07853890.2016.1231932.
10. Boulton AJM. The diabetic foot: epidemiology, risk factors and management. Diabetes Metab Res Rev. 2008;1):S3–S6., 24(Suppl). doi:10.1002/dmrr.833
11. 11.Tiwari S, Pratyush DD, Gupta B, Dwivedi A, Chaudhary S, Ray PS. Prevalence and risk factors of diabetic peripheral neuropathy in type 2 diabetic patients. J Diabetes Metab Disord. 2014; 13:55. DOI: 10.1186/2251-6581-13-55.
12. Shehab D, Al-Jarallah K, Mojiminiyi OA, Al Mohamedy H, Abdella NA. Does vitamin D deficiency play a role in peripheral neuropathy in type 2 diabetes? Diabet Med. 2012;29(1):43–49. DOI: 10.1111/j.1464-5491.2011.03439.x.
13. Lee P, Chen R. Vitamin D as an analgesic for patients with type 2 diabetes and neuropathic pain. Arch Intern Med. 2008; 168(7):771–72. DOI: 10.1001/archinte.168.7.771.
14. Basit A, Basit KA, Fawwad A, Shaheen F, Fatima N, Petropoulos IN, et al., Vitamin D for the treatment of painful diabetic neuropathy. BMJ Open Diabetes Res Care. 2016; 4:e000148. DOI: 10.1136/bmjdrc-2015-000148.
15. Bell DS. Reversal of the symptoms of diabetic neuropathy through correction of vitamin D deficiency in a type 1 diabetic patient. Case Rep Endocrinol. 2012:165056. DOI: 10.1155/2012/165056.
16. Melamed ML, Muntner P, Michos ED, Uribarri J, Weber C, Sharma J, et al., Serum 25-hydroxyvitamin D levels and the prevalence of peripheral arterial disease. Arterioscler Thromb Vasc Biol. 2008; 28(6):1179–85. DOI: 10.1161/ATVBAHA.108.165886.
17. Al Mheid I, Patel RS, Tangpricha V, Quyyumi AA. Vitamin D and cardiovascular disease: is the evidence solid? Eur Heart J. 2013;34(48):3691–98. DOI: 10.1093/eurheartj/eht166.
18. Norman PE, Powell JT. Vitamin D and cardiovascular disease. Circ Res. 2014;114(2):379–93. DOI: 10.1161/CIRCRESAHA.113.301241.
19. Tellechea A, Leal EC, Veves A, Carvalho E. Inflammatory and angiogenic abnormalities in diabetic wound healing. Diabetes Metab Res Rev. 2016; 1):107–14., 32(Suppl). DOI: 10.1002/dmrr.2749.
20. Burkiewicz CJ, Guaderrama A, Skare TL, Nassif PAN. Vitamin D and wound healing: a systematic review. Rev Col Bras Cir. 2012 and 39(5):401–05.
21. Razzaghi R, Pidar F, Momen-Heravi M, Bahmani F, Akbari H, Asemi Z. The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer. J Diabetes Complications. 2017;31(4):766–72. DOI: 10.1016/j.jdiacomp.2016.12.017
22. 22.Lips P, Eekhoff M, van Schoor N, Oosterwerff M, de Jongh R, Krul-Poel Y. Vitamin D and type 2 diabetes. J Steroid Biochem Mol Biol. 2017;173:280–85. DOI: 10.1016/j.jsbmb.2016.11.021.
23. 23.Aranow C. Vitamin D and the immune system. J Investig Med. 2011; 59(6):881–86. DOI: 10.2310/JIM.0b013e31821b8755.
24. Hewison M. Antibacterial effects of vitamin D. Nat Rev Endocrinol. 2011;7(6):337–45. DOI: 10.1038/nrendo.2010.226.
25. Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013;5(7):2502–21. DOI: 10.3390/nu5072502.
26. Zubair M, Malik A, Meerza D, Ahmad J. 25-hydroxyvitamin D levels and diabetic foot ulcer severity. Int J Low Extrem Wounds. 2013;12(4):289–95. DOI: 10.1177/1534734613507922.
27. Afarideh M, Ghajar A, Mohajeri-Tehrani MR. Relationship between vitamin D deficiency and diabetic foot ulcer: a systematic review. Diabetes Metab Syndr. 2020;14(5):1261–66. DOI: 10.1016/j.dsx.2020.07.008.
28. Pena G, Kuang B, Cowled P, Fitridge R. Micronutrients in diabetic foot ulcer healing: a systematic review. J Diabetes Complications. 2020; 34(4):107582. DOI: 10.1016/j.jdiacomp.2020.107582.
29. Tardáguila-García A, García-Morales E, García-Álvarez Y, Molines-Barroso RJ,Álvaro-Afonso FJ, Lázaro-Martínez JL. Relationship between vitamin D and diabetic foot disease. Int J Environ Res Public Health. 2021;18(4):1979. DOI: 10.3390/ijerph18041979.
30. Rayman G, Vas P, Dhatariya K, Driver V, Hartemann A, Londahl M, et al., Guidelines on interventions to enhance healing of foot ulcers in persons with diabetes. Diabetes Metab Res Rev. 2024;40(S1):e3783. DOI: 10.1002/dmrr.3783.
31. International Working Group on the Diabetic Foot (IWGDF). IWGDF Guidelines on the prevention and management of diabetic foot disease. Diabetes Metab Res Rev. 2023;39(Suppl 1):e3648. DOI: 10.1002/dmrr.3648.
32. Bus SA, Lavery LA, Monteiro-Soares M, Rasmussen A, Raspovic A, Sacco ICN, et al., Guidelines on the prevention of foot ulcers in persons with diabetes. Diabetes Metab Res Rev. 2023;39(S1):e3651. DOI: 10.1002/dmrr.3651.
33. Iannuzzo G, De Cristofaro T, Lupoli R, et al., Vitamin D deficiency and peripheral arterial disease: a meta-analysis. Nutr Metab Cardiovasc Dis. 2019;29(9):993-1001. DOI: 10.1016/j.numecd.2019.06.005.
34. Reis JP, Michos ED, von Mühlen D, Miller ER III. Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease. Circulation. 2008;117(19):2467-2473. DOI: 10.1161/CIRCULATIONAHA.107.735688
35. Qu GB, Wang LL, Tang X, Wu W, Sun YH. The association between vitamin D level and diabetic peripheral neuropathy in patients with type 2 diabetes mellitus: an update systematic review and meta-analysis. J Clin Transl Endocrinol. 2017;9:25–31.DOI: 10.1016/j.jcte.2017.04.001.
36. Tang W, Chen L, Ma W, et al., Association between vitamin D status and diabetic foot in patients with type 2 diabetes mellitus. J Diabetes Investig. 2022;13(7):1213–1221.DOI: 10.1111/jdi.13776.
37. Wang TT, Nestel FP, Bourdeau V, Nagai Y, Wang Q, Liao J, et al., Cutting Edge: 1,25-Dihydroxyvitamin D3 Is a Direct Inducer ofAntimicrobial Peptide Gene Expression. J Immunol. 2004;173(5):2909–2912. DOI: 10.4049/jimmunol.173.5.2909.
38. Liu L, Zhang F, Jamali M, Guimarães NS, Radkhah N, Jamilian P, Wang Q. The role of vitamin D in diabetic foot ulcer: an umbrella review of meta-analyses. Front Nutr. 2024;11:1454779. DOI: 10.3389/fnut.2024.1454779.
39. Hu Z, Wang Y, Zhang Y, et al., Association between vitamin D deficiency and risk of diabetic foot ulcers: a systematic review and meta-analysis. Nutrients. 2023; 15(4):921.
40. Gao YQ, Gao YH, Xing JH. Vitamin D supplementation reduces infection rate and promotes wound healing in diabetic foot ulcers. World J Diabetes. 2025;16(8):108166.DOI: 10.4239/wjd.v16.i8.108166.
41. Al-Rawaf HA, Gabr SA, Alghadir AH. Molecular changes in diabetic wound healing following administration of vitamin D and ginger supplements: biochemical and molecular experimental study. Evid Based Complement Alternat Med. 2019;2019:4352470. DOI:10.1155/2019/4352470.
42. Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, et al. ,Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg. 2006; 45(5 Suppl):S1-S60. doi:10.1016/S1067-2516(07)60001-5. doi: 10.1016/S1067-2516(07)60001-5.
43. Raveendran R, Jones S, Chandramohanadas R, et al., Vitamin D levels in diabetic foot ulcer patients: a meta-analysis. Int J Diabetes Dev Ctries. 2025; 46:76-84. DOI: 10.1007/s13410-025-01480-3.
44. Lin J, Mo X, Yang Y, Tang C, Chen J. Association between vitamin D deficiency and diabetic foot ulcer wound in diabetic subjects: a meta-analysis. Int Wound J. 2023;20(1):55–62. DOI: 10.1111/iwj.13836.
45. Benson R, Kurian SJ, Prasad SS, Banerjee B, Sudha Gururaj VK, Kunhikatta V, Velladath SU, Rodrigues GS, Hariharapura RC, Rao M, Munisamy M, Vishwanath S, Mukhopadhyay C, Miraj SS. Association ofSerum Vitamin D Status with Multidimensional Health Parameters in Patients with Diabetic Foot Infections: A Cross-Sectional Analysis in a Tertiary Healthcare Facility. Int J Low Extrem Wounds. 2025 Oct 21:15347346251385348. DOI: 10.1177/15347346251385348.
46. Bashir M, Gupta BK, Naushad O, Chandra N, Gupta A. Comparison of calcium, phosphorus and 25(OH)D₂ levels in sedentary and labourer females. Ann Clin Lab Sci. 2019;7(1):1-3 DOI:10.21767/2386-5180.100289.
Muzamil Bashir, Abid Ashraf , Binish Gulzar,Omar Naushad. From Deficiency to Recovery: Vitamin D’s Role in Diabetic Foot Ulcers. Biomedicine: 2026, 46(3): 163-170. https://doi.org/10.51248/v46i3.53