The management of neuropathic ulcers of the foot in diabetes by shock wave therapy

Biagio Moretti, Angela Notarnicola, Giulio Maggio, Lorenzo Moretti, Michele Pascone, Silvio Tafuri, Vittorio Patella, Biagio Moretti, Angela Notarnicola, Giulio Maggio, Lorenzo Moretti, Michele Pascone, Silvio Tafuri, Vittorio Patella

Abstract

Background: Diabetes is becoming one of the most common chronic diseases, and ulcers are its most serious complication. Beginning with neuropathy, the subsequent foot wounds frequently lead to lower extremity amputation, even in the absence of critical limb ischemia. In recent years, some researchers have studied external shock wave therapy (ESWT) as a new approach to soft tissue wound healing. The rationale of this study was to evaluate if ESWT is effective in the management of neuropathic diabetic foot ulcers.

Methods: We designed a randomized, prospective, controlled study in which we recruited 30 patients affected by neuropathic diabetic foot ulcers and then divided them into two groups based on different management strategies. One group was treated with standard care and shock wave therapy. The other group was treated with only standard care. The healing of the ulcers was evaluated over 20 weeks by the rate of re-epithelization.

Results: After 20 weeks of treatment, 53.33% of the ESWT-treated patients had complete wound closure compared with 33.33% of the control patients, and the healing times were 60.8 and 82.2 days, respectively (p < 0.001). Significant differences in the index of the re-epithelization were observed between the two groups, with values of 2.97 mm2/die in the ESWT-group and 1.30 mm2/die in the control group (p < 0.001).

Conclusion: Therefore, ESWT may be a useful adjunct in the management of diabetic foot ulceration.

Figures

Figure 1
Figure 1
The ulcer of case 9 in group A. The lesion was localized to the plantar surface of the 3rd intermetatarsal space and was 175 mm2 before ESWT.
Figure 2
Figure 2
Ulcer of case 9 in group A. The lesion healed after 52 days with a re-epithelization index of 3.4 mm2/die.
Figure 3
Figure 3
Ulcer of case 4 in group B. The lesion was localized to the plantar surface of the tarsus and was 145 mm2 before standard management.
Figure 4
Figure 4
Ulcer of case 4 in group B. The lesion healed after 90 days with a re-epithelization index of 1.6 mm2/die.
Figure 5
Figure 5
The steps of ultrasonic gel, plastic draping and shock wave administration at work in the study.

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