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Open Access Research article

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

Biagio Moretti135, Angela Notarnicola1*, Giulio Maggio2, Lorenzo Moretti1, Michele Pascone2, Silvio Tafuri4 and Vittorio Patella1

Author Affiliations

1 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

2 Plastic Surgery Unit, Faculty of Medicine and Surgery of University of Bari, General Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy

3 President of Course of Motor and Sports Sciences, Faculty of Medicine and Surgery of University of Bari, General Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy

4 Hygiene Section, Department of Biomedical Sciences and Human Oncology, Faculty of Medicine and Surgery of University of Bari, General Hospital, Piazza Giulio Cesare 11, 70124 Bari, Italy

5 SITOD, Italian Society of Shock Waves Therapy, Naples, Italy

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BMC Musculoskeletal Disorders 2009, 10:54  doi:10.1186/1471-2474-10-54

Published: 27 May 2009

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.

Trial registration

Current Controlled Trials ISRCTN21800909