Globally, about $1 trillion has been spent on diabetes-related treatment, a 338 percent increase over the last 17 years, according to the International Diabetes Federation. And yet, 3.4 million deaths were related to diabetes in 2024. This shows the massive strain diabetes has placed on health systems worldwide. One of the most common and debilitating complications of diabetes is non-traumatic lower limb amputation. Diabetes remains the leading cause of non-traumatic lower limb amputations globally. This is particularly true in low- and middle-income countries where diabetes is rising and complications are more frequent.

For example, the IDF Africa region and South and Central America regions report higher frequencies of diabetic peripheral neuropathy (numbness, tingling, and loss of sensation in the periphery) due to chronic hyperglycemia. Excess glucose is converted to sorbitol that accumulates inside neurons. This creates osmotic stress and eventually nerve injury. Loss of sensation leads to an imbalanced gait and pressure ulcers. These ulcers are prone to infection, especially when combined with vascular disease and an impaired immune response. Once infection reaches the bone, amputation becomes necessary to stop the spread.

Healing requires weeks of pressure redistribution, mechanical protection, and ongoing surveillance after amputations. Global health systems have invested heavily in surgical capacity, antibiotics, and infection control. But far less attention is paid to the infrastructure surgery depends on after the incision: pressure relief and offloading devices. Repetitive trauma and high plantar pressure can lead to new ulcers and recurrent infection. Offloading strategies include total contact casts, removable cast footwear, wedge footwear, half shoes, wheelchairs, and related devices. Total contact casting remains the gold standard for treating neuropathic ulcers, yet its availability is inconsistent in many regions.

How operational failures lead to clinical consequences

Providers often struggle with inconsistent supply chains that delay care in LMICs. Studies show that research initiatives should focus on local manufacturing and job creation to develop sustainable access to orthopedic devices. Many orthotic components are imported from high-income countries. This makes them vulnerable to high shipping costs, import taxes, and distributor markups.

When these fragile supply chains are disrupted, the consequences can be immediate. In Uganda in 2009, after the National Rehabilitation Centre was transferred to government control, supply chains collapsed and essential materials were depleted. Access narrowed to patients who could afford high out-of-pocket costs, and clinicians resorted to melting jerrycans in place of polypropylene for socket fabrication despite poor performance. The episode shows how weak national coordination of orthotic supply chains can tumble into unsafe conditions for both patients and providers.

This system-level breakdown most importantly affects patients who rely on physical labor for income in LMIC settings. Without proper equipment, stumps are exposed to repetitive pressure. This increases the risk of breakdown and infection. Additional barriers include shortages of trained orthotists and prosthetists, limited follow-up capacity, and a lack of consistent wound care supplies such as dressings and antibiotics. The paradox of it all: We amputate earlier where healing support is weakest, forcing us to simply accept the consequences as inevitable.

A solution: Integrating AI into offloading workflows

Step 1: Using Figma-based AI design for local manufacturing to enhance hybrid models

A hybrid model combines globally shared design systems with locally driven fabrication. This allows standardized knowledge to be adapted using regionally available materials and workflows. These models can be further strengthened by integrating a Figma-based, AI-supported collaborative design platform into the orthotic workflow. In this structure, global open-source orthotic templates would live in a shared, cloud-based design environment where clinicians and regional technicians can adapt devices in real time based on patient measurements, wound location, and pressure points.

A clinician could upload basic measurements or annotated photographs, adjust a template using a visual interface, and select from a menu of locally available materials. AI tools embedded within the platform could assist by suggesting pressure redistribution modifications, flagging biomechanical concerns, or automatically adjusting dimensions based on standardized designs. The design can be exported into printable templates for low-tech workshops using foam, rubber, cork, or silicone. This way, design intelligence remains globally shared, while production remains local and adaptable.

Importantly, the same platform can serve as a direct pipeline between clinical customization and procurement. Local orthotics creators and fabrication hubs could input current material inventory, fabrication capabilities, and production timelines into the system. The platform could automatically match the designs created by clinicians to locally available supplies, adjusted as if certain materials are unavailable. This generates a production-ready file or cutting template. This eliminates the disconnect between prescription and production, reduces reliance on imported components, and shortens turnaround time. By linking clinicians, technicians, and supply data within a shared digital workspace, we create an efficiently integrated pathway from prescription to delivery.

Step 2: Integration into surgical programs

Pressure-relief provision should be embedded directly into surgical care pathways rather than treated as a downstream add-on. Amputation and offloading must be delivered as a single, coordinated intervention, with a clear plan for mechanical protection in place at discharge. This approach moves away from sequential, charity-based models in which devices are donated intermittently or obtained weeks later, often after complications have already developed.

Instead, surgical programs should be structured so that pressure-relief devices are anticipated, fabricated or fitted early, and incorporated into routine postoperative protocols. Funding structures should also prioritize healing and limb preservation outcomes rather than reimbursing procedures only.

Step 3: Redefining post-amputation care as essential infrastructure

AI-integrated, Figma-based design systems could make post-amputation pressure relief a standard part of care instead of something done inconsistently. Each design could be linked to a patient, their wound characteristics, and the specific adjustments made. That information could then be tied to follow-up outcomes like healing time, infections, re-ulceration, need for revision surgery, and mobility.

These outcomes could be recorded during routine postoperative visits by surgeons, wound care teams, and local orthotic technicians in the same shared system. Over time, AI could look at these patterns and identify what works. For example, AI could identify which offloading designs reduce recurrence, which materials fail in certain climates, and which stump shapes need specific modifications.

In this three-step model, pressure redistribution is no longer an afterthought. It is tracked, improved, and treated as a core part of care, with success measured by real healing, not just discharge.

Adwait Chafale is a medical student.