Physical therapy in diabetic foot ulcer: Research progress and clinical application

Abstract

Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.

Keywords: diabetes foot ulcer; electrical stimulation; medical expenses; photobiomodulation therapy; physical therapy.

FIGURE 1

Contribution of innate immune cells and inflammation to timely and delayed wound healing. (A) Representation of the four phases of wound healing ([1] Haemostasis, [2] Inflammation, [3] Proliferation and [4] Tissue Remodelling). (B) Chronic wounds are stalled in the inflammatory stage. DAMPs, damage‐associate molecular patterns; PAMPs, pathogen‐associated molecular patterns; MMPs, matrix metalloproteinases; ROS, reactive oxygen species; AMPs, antimicrobial peptides; TIMPs, tissue inhibitor of metalloproteinases. Created with BioRender.com.Copyright 2021 Versey, da Cruz Nizer, Russell, Zigic, DeZeeuw, Marek, Overhage and Cassol.

FIGURE 2

Effect of prolonged low stress lowers thresholds for subsequent adaptation and injury. Copyright 2002, Oxford University Press.

FIGURE 3

The mechanism of generation of wound electric fields. COI, Current of Injury. Skin cells are recruited to the wound under the action of endogenous electric field formed by COI.

FIGURE 4

Mechanism of action of PBM therapy in wound healing. PBMT, photobiomodulation therapy; I, irradiation; CCO, cytochrome c oxidase; ATP, adenosine triphosphate; ROS, reactive oxygen species; NO, Nitric Oxide.