Utility of shock wave therapy in the treatment of diabetic foot ulcers

Dr. Jordi Asunción is an orthopedic surgeon, specialist in Foot and Ankle Surgery, with a wide and proven experience in the treatment of foot pathology and more specifically in diabetic foot pathology. He is currently the Coordinator of the Foot and Ankle Unit of the Hospital Clínic de Barcelona, where different courses and congresses are held annually for training in this specialty. He also coordinates the Diabetic Foot Unit of this hospital formed by a multidisciplinary group of prestigious specialists in this field.

Dr. Jordi Asunción, could you explain to us what is the diabetic foot?

Diabetic patients usually present foot problems secondary to the neuropathy and vasculopathy they develop, all these problems that occur in the foot of a diabetic person are called “diabetic foot”. Among the different pathologies, plantar ulcers are those that increase the risk of suffering serious complications that can lead to infection and amputation of the limb, which is a serious detriment to the patient.

How should a diabetic foot be treated?

The treatment of diabetic foot is aimed at avoiding the amputation of the foot, maintaining a useful and functional limb, using different orthopedic and surgical procedures, ranging from the use of support insoles and appropriate footwear to more complex surgeries such as arthrodesis. A very important role in this process is the treatment of plantar ulcers, and different resources must be used for their definitive healing. Shock wave therapy is an excellent alternative for this purpose, and can also be associated with other conventional treatments.

What are the effects of shock waves on diabetic foot ulcers?

Electrohydraulic shock waves are applied on the skin ulcer producing an induction effect for the regeneration of collagen tissue causing a release of growth factors that favor the appearance of new blood vessels and the proliferation and differentiation of fibroblasts, which translates as a stimulus that favors the healing of soft tissue. In addition, shock waves have a bactericidal effect as they also destroy the bacteria that are contaminating the ulcer thus avoiding a possible secondary infection.

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How is this treatment performed?

This treatment is performed on an outpatient basis in the doctor’s office, without requiring any type of anesthesia because it is completely painless, there is no contraindication to perform this procedure and presenting no side effects or undesirable. It is necessary to have a machine emitting electrohydraulic shock waves specifically designed for the treatment of this type of lesions (such as Dermagold 100 which is the one we have in our center) which are applied directly to the skin ulcer on which a sterile transducer gel is placed to avoid contamination. The amount of shock waves to be applied in each case will depend on the size and depth of the skin lesion, i.e. the larger the lesion, the more shock waves will be needed, repeating the treatment every two weeks until the ulcer is completely healed.

How long does it usually take for the ulcer to heal definitively?

Naturally this will depend on the size of the lesion to be treated, but in general we could say that it usually ranges from 3-5 sessions in minor lesions to 10-12 sessions for large ulcers.