Management of chronic diabetic foot skin ulcers require multidisciplinary approaches
including diabetic control, wound care, antibiotic, shoe wear off-loading, and surgery in
selected cases. The results are inconsistent and irregular, and most studies reported
unsatisfactory results. Many adjunctive therapies are implemented in the care of chronic
diabetic foot ulcers including hyperbaric oxygen therapy (HBO), ultrasound, recombinant human
platelet-derived growth factor-BB (rPDGF-BB), vacuum assisted wound closure (VAWC) and
acellular matrix. HBO is the most commonly utilized at the investigators institution. Mixed
results of HBO in chronic diabetic foot ulcers are reported. Several studies reported that
the beneficial effects of HBO, but none showed universal success. Therefore, the development
of a new effective method of treatment for chronic diabetic ulcers is extremely valuable.
Extracorporeal shockwave therapy (ESWT) acts as mechanotransduction that produces the
therapeutic benefits through complex biological pathways including neovascularization and
tissue regeneration. ESWT also showed bacteriostatic effects in experiments. Some studies
reported the effectiveness of ESWT in acute and chronic soft tissue wounds. Others reported
effectiveness of ESWT in chronic ulcers with 50% completely healed with 6 sessions of
treatment. With this background, it appears that ESWT may be effective in the treatment of
chronic diabetic foot ulcers. The purpose of this study is to evaluate the efficacy of ESWT
in chronic foot ulcers, and to compared with that treated with HBO, and to study the
molecular and blood flow perfusion before and after ESWT.