Because the chronic ulcer of the foot in diabetes is often unresponsive to standard care, there has been considerable interest in the potential benefit of so-called "advanced wound therapies"--many of which have a biological basis. This article summarizes the findings of earlier systematic reviews, together with the findings of more recent publications. The available evidence suggests that while some biological therapies offer promise, more work is needed to substantiate their role in clinical practice. This conclusion needs to be placed in the context of very strong observational data demonstrating the major improvements that can accompany changes to the way in which wound care is delivered with, in particular, the introduction of multidisciplinary team work and more rapid referral for expert assessment.