External Shock therapy for Diabetic foot

Individuals with diabetes who have an ulcer or an open wound on the leg or foot often go through numerous procedures to help the wound heal. The primary problem in many diabetics is poor blood supply but a number of diabetics also develop neuropathic ulcers from pressure or trauma and have good blood supply. At present, the conventional treatments to heal diabetic foot ulcer include treatment of infection, debridement, relief from any pressure and restoring blood supply to the leg or foot. Despite the wide variety of present treatments, the majority of wounds in diabetic never heal with these therapies. In the end, many diabetics end up having amputations of a toe(s), foot, or leg.

Over the last few years, Italian scientists have been studying the role of external shock wave therapy (ESWT) and promotion of healing of certain diabetic foot ulcers. The Italian scientists started to experiment with shock wave therapy in combination with the current standard treatment. Their research work revealed that shock waves could help tissues heal.

In a small study of 30 patients with diabetic foot ulcers, patients were administered shock wave therapy administered every 1-2 minutes for 72 hours at a time. After 20 weeks, only 50% of diabetics had wound closure in 60 days. Of the Diabetics who were treated with conventional therapy, 33% had wound closure in a slightly longer time interval.

With these results, the Italians are now promoting external shock wave therapy to heal all types of ulcers.

Long Term Complications of Diabetes

Both type 1 and type 2 diabetes have profound long term complications if the blood sugar is not well controlled. These complications usually take years to establish but in some cases may occur prematurely if the individual smokes and is non compliant with therapy. The complications are not only irreversible but can be life or limb threatening. The most common long term complications of diabetes include:

Heart disease: The majority of diabetics will develop narrowing of blood vessels in the heart. This will lead to a decrease in blood supply and hence decreased oxygen to the heart. Heart attacks and congestive heart failure are common in diabetes for this reason. Further, the coronary vessels narrow extensively and neither medical treatment nor surgery is an effective solution. Almost 3/4th of diabetics die from heart disease. While there is no sure fool proof method of preventing heart disease in diabetics, it is recommended that the blood sugar be tightly controlled and that the individual take an aspirin on a regular basis.

Neuropathy (nerve damage): With time almost all diabetic develop some degree of nerve damage. All nerves in the body can be affected by diabetes but it is the nerves in the legs that are most affected. The typical signs and symptoms of nerve damage include tingling, numbness, burning or pain that usually begins in the toes and migrates upwards. Often this nerve pain is confused with blood insufficiency. When the nerve damage progresses, one can lose all sensation. When the sensation is lost, the majority of diabetics develop serious infections and trauma to their joints and bone, often leading to amputations. Nerve damage cannot be completely prevented but can be delayed by better sugar control.

Kidney damage (nephropathy): One of the most serious complications of diabetes is kidney damage. Initially, diabetics may filter out the body protein in small amounts. If this is neglected, the kidney damage progresses and leads to complete shutdown. Once the kidney fails, all diabetics end up on dialysis or require a kidney transplant. The prognosis of diabetic patients with renal failure is poor.

Eye damage: diabetes can damage the blood vessels of the inner eye and lead to blindness. Other complications include cataracts, glaucoma and retinal detachment. To prevent these complications, it is essential that all patients regularly see their eye doctor.

Diabetic foot: diabetes causes narrowing of the blood vessels in the legs. Over time this leads to decreased blood supply to the feet. The individual may complain of pain in the thigh or legs when walking. Even minor trauma can lead to a serious infection(s) which can threaten the limb. The combination of narrowed blood vessels and neuropathy often leads to amputation of the limbs/toes in most diabetics.

Oral care: Almost all diabetics develop infections and ulcers in their mouth and gums. This is more likely to occur if the blood sugar levels are not controlled. Proper hygiene and blood glucose control are vital if oral care is to succeed. Poor oral hygiene worsens the prognosis. It is essential that all diabetics regularly see an oral hygienist. It is now believed that diabetes can also lead to premature development of osteoporosis and Alzheimer’s disease.

The only way to prevent the long term complications of diabetes is by better sugar control, maintaining a healthy weight and a eating a proper diet.

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