## 1 Introduction  
Diabetic Foot Syndrome (DFS) is defined by the World Health Organization as an ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischaemia and infection [1]. The 10 th edition of the _Diabetes Atlas_, published in July 2023 by the International Diabetes Federation, estimated that in 2021, 536.6 million individuals between the ages of 20 and 79 years were living with diabetes worldwide. The overall prevalence of diabetes worldwide among this demographic was 10.5%. It is notable that these data vary considerably from one region to another. For instance, the total number of people with diabetes was estimated at 61.4 million in Europe and 50.5 million in North America and the Caribbean, reaching 205.6 million in the Western Pacific region. The highest prevalence rate was calculated for the Middle East and North Africa, with a total of 16.2%. It is estimated that by 2045, the number of people living with diabetes will reach 783.2 million [2]. In 2021, the total estimated global healthcare expenditure for individuals aged 20-79 years was 966 billion USD. The highest global expenditure was observed for men aged 60-69 years (132.5 billion USD), representing a 27.5% increase compared to the expenditure for women of the same age. The projected expenditure for adults in 2045 was estimated at USD 1054 billion, representing an increase of 9.1% compared to that in 2021 [2]. DFS is associated with a number of conditions, including sensitive and motor neuropathy (which can result in foot deformities), peripheral artery disease (PAD), soft tissue infections and even osteomyelitis. It is estimated that approximately 50% of diabetic foot ulcers (DFUs) manifest on the plantar surface [3]. Neuropathy in diabetes is a heterogenous group of disorders that differ in terms of their clinical presentation and underlying pathophysiological mechanisms. Neurological alterations manifest at the sensory, motor and autonomic levels, resulting in dysfunction in the perception of thermoreceptors (cold or heat) and mechanoreceptors (pressure and vibration). Neuropathies can be classified as either \"diffuse or symmetrical\" (distal symmetrical polynneuropathy, acute autonomic and sensory neuropathy) or \"focal or multifocal\" (radicular plexus neuropathy, entrapment syndromes, cranial palsies and other monone neuropaths) [4]. The vascular alterations originate at the cellular level, manifesting as modified endothelial cell function and a subsequent reduction in vasodilator production, which in turn results in vasoconstriction. Furthermore, increased thromboxane A2 production results in hypercoagulation, thereby increasing the risk of ischaemia and ulceration [5]. In accordance with the findings of [PERSON] et al. [6], the probability of actual breakdown and ulceration of the plantar soft tissue, in the event of a loss of painful sensation, is contingent upon three factors:  
1. The presence of diabetic neuropathy and its associated complications in the foot;
2. The magnitude of the forces exerted upon the foot;
3. The distance walked that results in the onset of tissue inflammation. It is still considered that foot pressure represents a significant risk factor for the onset of foot complications. However, this is an inadequate method for predicting the onset of ulcers, as the predictive values cannot be determined [7,8]. The low specificity and sensitivity (46.3% and 63.5%, respectively) demonstrated by these studies for maximum pressures as pathological indicators suggest that pressure cannot be the sole factor associated with the development of plantar ulcers. In addition to plantar pressures, shear forces also have an important role to play in the development of diabetic foot lesions. Such forces can predict the location of higher shear pressure zones and increase plantar temperature, thereby accelerating tissue breakdown and leading to ulceration.