Extracorporeal shockwave therapy for the treatment of chronic diabetic foot ulcers: a clinical perspective. Kenneth Craig * *Director – Kompass Centre for Shockwave Therapy, Auckland. Abstract Introduction

Amputations are the consequence of chronic unresponsive diabetic foot ulcers due to small vessel occlusion and the persistent

limb ischemia, compounded with neuropathy and infection. Despite guidelines and developments in this discipline the

management and treatment of chronic diabetic ulcers remain challenging with limited success. Extracorporeal shockwave

therapy (ESWT) has been used for the treatment of chronic diabetic ulcers with promising results.

Aim

To highlight ESWT and encourage the initiation of a local trial to further assess its efficacy for the treatment of chronic and

complicated diabetic ulcers.

Discussion

The cause of diabetic foot ulcers is multifactorial and its management requires a multidisciplinary approach with the primary goal

being the control of blood sugar levels and avoid complications. However, the complex and recurrent refractory chronic foot ulcer

that responds inconsistently to various surgical and nonsurgical treatments may inevitably lead to amputations. Therefore,

chronic diabetic foot ulcer remains as an unresolved medical entity.

Although the exact mechanism of ESWT is yet to be fully elucidated, studies have demonstrated that stimulus from ESWT

triggers a favorable neurobiocellular and chemical process impacting regional microcirculation, inflammation, neuronal

signaling, and growth factor proliferation, while having anti-bacterial properties. Investigations conducted by Mittermayr et al

(2011), Saggini et al(2008) and Wang et al (2008) all yielded promising results on chronic wounds and ulcers with or without the

complications of diabetes. Wang et al (2008) found ESWT to be more effective when compared to hyperbaric oxygen therapy

(HBOT) for the treatment of chronic diabetic ulcers.

Conclusion

ESWT offers a noninvasive, minimal risk and readily applicable treatment modality which can accelerate tissue repair and

provide an effective treatment response. Its favorable risk-benefit ratio and proposed mechanism of action warrants further

investigation of its use for the treatment of chronic diabetic foot ulcers.