The Impact of Extracorporeal Shock Wave Therapy on Microcirculation in Diabetic Feet: A Pilot Study

Abstract

BACKGROUND Patients with diabetic foot commonly experience vascular insufficiency and compromised tissue perfusion. Extracorporeal shockwave therapy (ESWT) reportedly promotes wound healing and angiogenesis, but clinical studies on the effect of ESWT on angiogenesis are scarce and the exact mechanism remains unclear. OBJECTIVE To investigate the effect of ESWT on cutaneous microcirculation in diabetic feet. METHODS Ten patients with diabetic feet received ESWT twice weekly for a total of six sessions. Transcutaneous partial oxygen pressure (Tcpo 2) and cutaneous blood flow were measured before and after ESWT. MAIN RESULTS The treated feet showed statistically significant improvements in the mean Tcpo 2 (P < .01) and cutaneous blood flow level (P < .05) compared with control feet. In treated feet, Tcpo 2 increased by 19.6%, from 41.4 ± 9.9 to 49.5 ± 8.7 mm Hg (P < .05). In control feet, Tcpo 2 decreased by 11.6%, from 39.5 ± 14.0 to 34.9 ± 14.5 mm Hg (P = .059). The average cutaneous blood flow level of treated feet before ESWT was 36.9 ± 25.6, which increased to 48.3 ± 32.4 AU after ESWT (30.9% increase; P = .646). In control feet, the cutaneous blood flow level decreased from 80.5 ± 36.7 to 60.4 ± 38.8 AU, a decrease of 25.0% (P = .241). CONCLUSIONS These results demonstrate that ESWT may have beneficial effects on microcirculation in diabetic feet.

Microenergy acoustic pulses promotes muscle regeneration through in situ activation of muscle stem cells

“…Results from our study shows that MAP significantly increased proliferation and migration of endothelial cells that leads to the upregulation of the vascular density in muscle after IRI. The effect of extracorporeal shock wave therapy on microcirculation and blood vessel development has also been reported in previous human studies 31,32 . As one of the important stem/progenitor cells in muscle, endothelial cells have been found to support the muscle regenerating process.…”

“…Results from our study shows that MAP significantly increased proliferation and migration of endothelial cells that leads to the studies. 31,32 As one of the important stem/progenitor cells in muscle, endothelial cells have been found to support the muscle regenerating process. Besides providing blood supply, it can also secrete growth factors such as IGF-1 that influencing the proliferation and differentiation of satellite cells.…”

Effect of different thermal stimuli on improving microcirculation in the contralateral foot

“…Clinical methods to treat dysfunction microcirculation include drugs [ 6 ] and physical agents (e.g., heating [ 7 – 9 ], mechanical stimulations [ 10 , 11 ], extracorporeal shock wave [ 12 ], electromagnetic field stimulation [ 13 ], transcutaneous electrical nerve stimulation [ 14 ], etc.). As a convenient, safe and effective method, heating is often used in clinical treatment and daily life to promote blood circulation, nutritional supply, wound healing and tissue repair [ 15 , 16 ].…”

Effect of different thermal stimuli on improving microcirculation in the contralateral foot

“…Clinical methods to treat dysfunction microcirculation include drugs [6] and physical agents (e.g. heating [7][8][9], mechanical stimulations [10,11], extracorporeal shock wave [12], electromagnetic eld stimulation [13], transcutaneous electrical nerve stimulation [14], etc.). As a convenient, safe and effective method, heating is often used in clinical treatment and daily life to promote blood circulation, nutritional supply, wound healing and tissue repair [15,16].…”