A Novel Bathing Therapeutic Approach for Diabetic Foot Ulcers

Abstract

Ineffective healing and treatment of foot ulcers can lead to an infection and gangrene of the wound area that ultimately results in the loss of the limb. The incidence of foot ulcers is higher in patients with diabetes, peripheral vascular disease and kidney disease. Accordingly, this study was undertaken to assess the ability of foot bathing in CO2-enriched water to heal foot ulcers. The design was a double-blinded, randomized, placebo-controlled study. Patients with at least one foot ulcer were randomized to receive either a treatment with bath therapy at 37 ± 0.5 °C containing either 1000–1200 ppm CO2-enriched tap water (the intervention) or non-carbonated tap water at 37 ± 0.5 °C (the control group). Treatment was conducted three times/week for 15 min per session for up to 16 weeks for a total of 48 treatment sessions. Before and at the end of every treatment month, wound size, wound area oxygenation and the ankle brachial index were measured. In addition, the McGill pain questionnaire was conducted. Blood was also collected at these time points (for a total of five collections) for the measurement of different biomarkers. While no significant differences (p < 0.05) in the group/time interaction effect were observed, a clear separation within the wound area reduction/wound area/oxygenated Hb outcomes was seen between placebo (control) and treatment (CO2) group. This pilot study is suggestive that bathing in CO2-enriched water may accelerate the healing of foot ulcers.

Modification of Peripheral Blood Flow and Angiogenesis by CO2 Water-Bath Therapy in Diabetic Skeletal Muscle with or without Ischemia

“…In view of higher incidence of ulcers in patients with diabetes, bathing in CO 2 -enriched water has been reported to accelerate healing of foot ulcers [28]. We have also observed that 4 weeks of CO 2 therapy augmented the blood flow and angiogenesis in the skeletal muscle of 6 weeks diabetic-ischemic hind limb of rats [25].…”

“…Since diabetes is associated with several risk factors including hypertension for inducing vascular complications, it would be valuable to examine the effectiveness of CO 2 waterbath therapy by employing diabetic-hypertensive animals. Nonetheless, a preliminary study in diabetic patients with foot ulcers has shown some promising results with CO 2 water-bath treatment [28], and it is hoped that a large clinical trial will be undertaken to establish beneficial effects of CO 2 therapy for the treatment of vascular complications in diabetic patients.…”

“…Such beneficial effects of balneotherapy are considered to be due to marked vasodilatory and anti-inflammatory actions of CO 2 . In fact, both clinical and experimental investigations have revealed that CO 2 therapy improves blood flow in the ischemic limb in PAD [4,[19][20][21][22][23][24][25][26][27][28]. Due to the microcirculation promoting effect of CO 2 , angiography using CO 2 has been employed to monitor immediate response to endovascular therapy of PAD [29][30][31][32].…”