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


CONCLUSIONS
Therefore, ESWT may be a useful adjunct in the management of diabetic foot ulceration.
Moretti
Biagio
B
Department of Clinical Methodology and Surgical Techniques, Orthopedics Section, Faculty of Medicine and Surgery of University of Bari, General Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy. b.moretti@ortop2.uniba.it
Notarnicola
Angela
A
Maggio
Giulio
G
Moretti
Lorenzo
L
Pascone
Michele
M
Tafuri
Silvio
S
Patella
Vittorio
V
D000368:Aged; D001808:Blood Vessels / Q000502:physiology; D017719:Diabetic Foot / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D003929:Diabetic Neuropathies / Q000150:complications*; D004847:Epithelial Cells / Q000502:physiology; D005260:Female; D005528:Foot / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D016523:Foot Ulcer / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic / Q000502:physiology; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods* / Q000706:statistics & numerical data; D014465:Ultrasonics; D014945:Wound Healing / Q000502:physiology; D014946:Wound Infection / Q000188:drug therapy / Q000453:epidemiology