# Automatic Foot Ulcer Segmentation Using an Ensemble of Convolutional Neural Networks

arXiv: https://arxiv.org/abs/2109.01408 · HTML: https://mlsanity.com/paper/2109.01408/

## Key facts

- Cited by 9 papers in the map (data through 14 Oct 2026).
- Builds on 13 of its 35 references that are in the map.
- First posted on arXiv 3 Sep 2021.

## Builds on (most cited first, 13 of 13)

- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [YOLOv3: An Incremental Improvement](https://mlsanity.com/paper/1804.02767/) (2018)
- [UNet++: A Nested U-Net Architecture for Medical Image Segmentation](https://mlsanity.com/paper/1807.10165/) (2018)
- [Attention U-Net: Learning Where to Look for the Pancreas](https://mlsanity.com/paper/1804.03999/) (2018)
- [LinkNet: Exploiting Encoder Representations for Efficient Semantic Segmentation](https://mlsanity.com/paper/1707.03718/) (2017)
- [CryoNuSeg: A Dataset for Nuclei Instance Segmentation of Cryosectioned H&E-Stained Histological Images](https://mlsanity.com/paper/2101.00442/) (2021)
- [Fully Automatic Wound Segmentation with Deep Convolutional Neural Networks](https://mlsanity.com/paper/2010.05855/) (2020)
- [Fully Convolutional Networks for Diabetic Foot Ulcer Segmentation](https://mlsanity.com/paper/1708.01928/) (2017)
- [The Effects of Skin Lesion Segmentation on the Performance of Dermatoscopic Image Classification](https://mlsanity.com/paper/2008.12602/) (2020)
- [Deep Learning Approach to Diabetic Retinopathy Detection](https://mlsanity.com/paper/2003.02261/) (2020)
- [Investigating and Exploiting Image Resolution for Transfer Learning-based Skin Lesion Classification](https://mlsanity.com/paper/2006.14715/) (2020)

## Built on by (most cited first, 9 of 9)

- [FUSeg: The Foot Ulcer Segmentation Challenge](https://mlsanity.com/paper/2201.00414/) (2022)
- [Translating Clinical Delineation of Diabetic Foot Ulcers into Machine Interpretable Segmentation](https://mlsanity.com/paper/2204.11618/) (2022)
- [FUSegNet: A Deep Convolutional Neural Network for Foot Ulcer Segmentation](https://mlsanity.com/paper/2305.02961/) (2023)
- [Wound Tissue Segmentation in Diabetic Foot Ulcer Images Using Deep Learning: A Pilot Study](https://mlsanity.com/paper/2406.16012/) (2024)
- [An Enhanced Harmonic Densely Connected Hybrid Transformer Network Architecture for Chronic Wound Segmentation Utilising Multi-Colour Space Tensor Merging](https://mlsanity.com/paper/2410.03359/) (2024)
- [TransUNet-GradCAM: A Hybrid Transformer-U-Net with Self-Attention and Explainable Visualizations for Foot Ulcer Segmentation](https://mlsanity.com/paper/2508.03758/) (2025)
- [Improving Limited Supervised Foot Ulcer Segmentation Using Cross-Domain Augmentation](https://mlsanity.com/paper/2401.08422/) (2024)
- [Beyond Labels: Zero-Shot Diabetic Foot Ulcer Wound Segmentation with Self-attention Diffusion Models and the Potential for Text-Guided Customization](https://mlsanity.com/paper/2504.17628/) (2025)
- [Self-Attention Diffusion Models for Zero-Shot Biomedical Image Segmentation: Unlocking New Frontiers in Medical Imaging](https://mlsanity.com/paper/2503.18170/) (2025)

## Abstract (arXiv)

Foot ulcer is a common complication of diabetes mellitus and, associated with substantial morbidity and mortality, remains a major risk factor for lower leg amputations. Extracting accurate morphological features from foot wounds is crucial for appropriate treatment. Although visual inspection by a medical professional is the common approach for diagnosis, this is subjective and error-prone, and computer-aided approaches thus provide an interesting alternative. Deep learning-based methods, and in particular convolutional neural networks (CNNs), have shown excellent performance for various tasks in medical image analysis including medical image segmentation. In this paper, we propose an ensemble approach based on two encoder-decoder-based CNN models, namely LinkNet and U-Net, to perform foot ulcer segmentation. To deal with a limited number of available training samples, we use pre-trained weights (EfficientNetB1 for the LinkNet model and EfficientNetB2 for the U-Net model) and perform further pre-training using the Medetec dataset while also applying a number of morphological-based and colour-based augmentation techniques. To boost the segmentation performance, we incorporate five-fold cross-validation, test time augmentation and result fusion. Applied on the publicly available chronic wound dataset and the MICCAI 2021 Foot Ulcer Segmentation (FUSeg) Challenge, our method achieves state-of-the-art performance with data-based Dice scores of 92.07% and 88.80%, respectively, and is the top ranked method in the FUSeg challenge leaderboard. The Dockerised guidelines, inference codes and saved trained models are publicly available at https://github.com/masih4/Foot_Ulcer_Segmentation.