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14-02-2011 | Diabetes | Article

Extracorporeal shockwave trumps hyperbaric oxygen for diabetic foot ulcers


Free abstract

MedWire News: Extracorporeal shockwave therapy (ESWT) is more effective than hyperbaric oxygen therapy (HBOT) for treating chronic diabetic foot ulcers, suggest study results.

The efficacy of both techniques was compared in 77 diabetic patients with chronic foot ulcers. Of these, 38 (40 feet) were randomly assigned to receive 40 sessions of HBOT (2.5 atmospheres absolute for 90 minutes in total) and 39 (44 feet) to receive six twice-weekly treatments with ESWT (equivalent to 0.23 mJ/mm2 energy flux density at a rate of 4 shocks/second).

Ching-Jen Wang (Chang Gung University College of Medicine, Kaohsiung, Taiwan) and colleagues report that of the patients treated with ESWT, 57% demonstrated complete ulcer healing, 32% had an improvement of 50% or greater, and 11% had no change. HBOT-treated patients had significantly worse outcomes than ESWT patients, with corresponding rates of 25%, 15%, and 60%, respectively.

Blood perfusion rates were similar between the two groups at baseline, but showed significantly greater improvement among the ESWT than the HBOT group. Cell proliferation also increased and cell apoptosis decreased more in the ESWT than the HBOT group.

HBOT has shown some success in promoting healing of diabetic foot ulcers, as previously reported by MedWire News, but has limitations due to expense and limited availability of equipment.

While being used to improve fracture treatment, ESWT has previously demonstrated potential for improving wound healing in humans, and for stimulating the growth of healthy tissue in animal studies.

"ESWT has been shown to cause shear forces within tissues that initiate a biological response at a cellular level producing angiogenic growth factors… which are known to be present during normal wound healing," explain Wang and team.

"The increased perfusion response is an immediate inflammatory reaction to acoustic waves that put shear stress and mechanical forces on the microcirculatory system. By elevating perfusion in the wound area, the ischemic component of the chronic wound disease state is decreased immediately within a wound healing environment."

The results of this study suggest that ESWT should be investigated further for treatment of diabetic foot ulcers in a larger study group, suggest the authors.

The results of this study are published in the journal Diabetes, Research and Clinical Practice.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Helen Albert