Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;20(6):2303-2320.
doi: 10.1111/iwj.14035. Epub 2022 Dec 3.

Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review

Louise Hitchman  1 , Joshua Totty  1   2 , George E Smith  1   2 , Daniel Carradice  1   2 , Maureen Twiddy  3 , Cynthia Iglesias  4 , David Russell  5   6 , Ian C Chetter  1   2
Affiliations

Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review

Louise Hitchman et al. Int Wound J. 2023 Aug.

Abstract

Emerging evidence suggests that extracorporeal shockwave therapy (ESWT) may improve time to DFU healing. The aim of this review was to appraise the evidence on role of ESWT in DFU healing and impact of different ESWT doses. Databases were searched for trials comparing ESWT plus standard care to standard care alone in participants with DFUs. Search results were reviewed by two independent reviewers. The Cochrane Risk of Bias 2 tool and GRADE approach was used to assess bias and certainty. The primary outcome was time to healing. The search identified 345 papers after duplicates removed. Six trials consisting of 471 participants were included. There was unclear or high risk of bias across all domains. Time to ulcer healing was probably shorter in patients treated with ESWT compared with standard ulcer care alone (GRADE: low certainty). Patients treated with ESWT were more likely to heal at 20 weeks post-ESWT compared with those treated with standard ulcer care alone (GRADE: low certainty). There was significant heterogeneity. ESWT remains a promising new treatment but the translation into routine clinical practice is still limited by the low certainty of evidence surrounding its effectiveness, case selection and optimum dose.

Keywords: diabetic foot; extracorporeal shockwave therapy; foot ulcer; shockwave therapy; wound healing.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Ovid®MEDLINE®ALL search strategy for randomised controlled trials comparing extracorporeal shockwave to standard care alone in patients with diabetic foot ulcers
FIGURE 2
FIGURE 2
The Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) flow diagram of randomised controlled trials comparing extracorporeal shockwave to standard care alone in patients with diabetic foot ulcers
FIGURE 3
FIGURE 3
Risk of bias of the included randomised controlled trials comparing extracorporeal shockwave to standard care alone in patients with diabetic foot ulcers. Green + = low risk of bias; Yellow? = unclear risk of bias; Red − = high risk of bias.
See this image and copyright information in PMC

References

    1. Diabetes UK. Diabetes Statistics. 2021. London: The British Diabetics Association. https://www.diabetes.org.uk/professionals/position-statements-reports/st...
    1. World Health Organisation . Diabetes. 2022. Swizerland: World Health Organisation. https://www.who.int/health-topics/diabetes
    1. Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367‐2375. - PubMed
    1. Ince P, Game FL, Jeffcoate WJ. Rate of healing of neuropathic ulcers of the foot in diabetes and its relationship to ulcer duration and ulcer area. Diabetes Care. 2007;30(3):660‐663. - PubMed
    1. Neville RF, Kayssi A, Buescher T, Stempel MS. The diabetic foot. Curr Probl Surg. 2016;53(9):408‐437. - PubMed

Publication types