Aim: This review summarizes the available evidence on the management of diabetic foot ulcers using tunneling or undermining and identifies potential gaps in the current research. Methods: A scoping review was conducted according to the PRISMA-ScR guidelines. Four databases (Medline, Scopus, Google Scholar, and PubMed) were searched in May 2025 using a combination of terms related to diabetic foot ulcer, tunneling, and undermining. Two independent researchers screened the articles according to the inclusion criteria and extracted the data. The inclusion criteria were original articles/case reports, studies involving patients with diabetic foot ulcers, and studies on the management strategies of diabetic foot ulcers with tunneling or undermining. Results: The search yielded 115 articles, of which five were included. The included studies were published between 2009 and 2024. Three studies reported that acellular dermal matrix (ADM) is effective for diabetic foot ulcers with tunneling. In contrast, another study reported that debridement of all surface areas, compression, and immobilization were effective for diabetic foot ulcers with undermining. Conclusion: The management strategies for diabetic foot ulcers with tunneling and undermining include ADM, debridement, compression, and immobilization. While this scoping review does not aim to establish the statistical or clinical effectiveness of one intervention over another, it clearly uncovers a substantial knowledge gap and a lack of standardized protocols in the current literature. Further research is needed to develop specific recommendations based on tunnel and undermining sizes.
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