This document discusses using extracorporeal shockwave therapy (ESWT) to treat chronic diabetic foot ulcers. It notes that amputations are often the result of unresponsive ulcers caused by vessel occlusion and ischemia compounded by neuropathy and infection. While guidelines exist, treatment remains challenging with limited success. Studies have shown ESWT yields promising results for chronic ulcers, with one finding it more effective than hyperbaric oxygen therapy. The document concludes ESWT provides a noninvasive treatment that can accelerate tissue repair and merits further investigation for chronic diabetic foot ulcers due to its risk-benefit ratio and proposed healing mechanisms.

1. Extracorporeal shockwave therapy for the treatment of chronic diabetic foot ulcers: a clinical perspective.
Kenneth Craig *
*Director – Kompass Centre for Shockwave Therapy, Auckland.
Abstract
Introduction
Amputations are the consequence of chronic unresponsive diabetic foot ulcers due to small vessel occlusion and the persistent
limb ischemia, compounded with neuropathy and infection. Despite guidelines and developments in this discipline the
management and treatment of chronic diabetic ulcers remain challenging with limited success. Extracorporeal shockwave
therapy (ESWT) has been used for the treatment of chronic diabetic ulcers with promising results.
Aim
To highlight ESWT and encourage the initiation of a local trial to further assess its efficacy for the treatment of chronic and
complicated diabetic ulcers.
Discussion
The cause of diabetic foot ulcers is multifactorial and its management requires a multidisciplinary approach with the primary goal
being the control of blood sugar levels and avoid complications. However, the complex and recurrent refractory chronic foot ulcer
that responds inconsistently to various surgical and nonsurgical treatments may inevitably lead to amputations. Therefore,
chronic diabetic foot ulcer remains as an unresolved medical entity.
Although the exact mechanism of ESWT is yet to be fully elucidated, studies have demonstrated that stimulus from ESWT
triggers a favorable neurobiocellular and chemical process impacting regional microcirculation, inflammation, neuronal
signaling, and growth factor proliferation, while having anti-bacterial properties. Investigations conducted by Mittermayr et al
(2011), Saggini et al(2008) and Wang et al (2008) all yielded promising results on chronic wounds and ulcers with or without the
complications of diabetes. Wang et al (2008) found ESWT to be more effective when compared to hyperbaric oxygen therapy
(HBOT) for the treatment of chronic diabetic ulcers.
Conclusion
ESWT offers a noninvasive, minimal risk and readily applicable treatment modality which can accelerate tissue repair and
provide an effective treatment response. Its favorable risk-benefit ratio and proposed mechanism of action warrants further
investigation of its use for the treatment of chronic diabetic foot ulcers.