Dr. Angela Notarnicola, from the University of Bari, Italy, and co-researchers reported that at least 15% of diabetics develop lower-extremity ulcers. The standard treatment for foot ulcers at present includes treatment of any infection, debridement, pressure relief, and arterial revascularization if needed. Many ulcers, however, do not respond to these treatments.

According to recent evidence ESWT could enhance soft tissue wound healing, but whether it was useful for diabetic foot ulcers was unclear.

The rationale for the use of ESWT as an adjunctive treatment for the diabetic foot arises from its beneficial effects on the microenvironment of the wound. It stimulates physiological angiogenesis, due to the release of nitric oxide and vascular growth factors at the site of the ulcer, the authors explain.

In the new study, Dr. Notarnicola’s team compared outcomes in 30 patients with diabetic foot ulcers who were randomized to receive standard care alone or with ESWT, which was given for one or two minutes every 72 hours.

Following 20 weeks of treatment, the complete wound closure rate was 53.3% in the ESWT group compared with 33.3% in the control group, according to the report in the May 27th online issue of BMC Musculoskeletal Disorders.

The average healing time in the ESWT group was also shorter than in the control group: 60.8 vs. 82.2 days (p < 0.001). Moreover, the index of re-epithelialization value was significantly higher in the ESWT group (p < 0.001).

One subject in each group had evidence of local infection and received 10 days of oral antibiotics. The infection resolved in 5 days for the ESWT patient and in 7 days for the control patient. Both subjects completed the study.

Our new results reinforce the interest in applying ESWT to ulcers associated with neuropathy and macroangiopathy, the authors state. On the basis of these results, we can hypothesize that ESWT should also be valid for arteriogenic ulcers, and we are planning a new clinical trial to evaluate the effects of ESWT on this type of ulcer.