10
VOLUME 14 NUMBER 1 • JULY 2017
REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
quality of life. Identifying a treatment modality to help resolve this
complication remains a difficult task in clinical practice. However a
number of clinical trials suggest LLLT as an alternative and promising
treatment modality that, when combined with other conventional
treatments, has shown potential in improving the healing rate of
chronic diabetic ulcerations. It is therefore essential to recognise
that with the use of LLLT in podiatry and other wound clinics, the
treatment or management of chronic diabetic lower-limb ulcerations
can be reduced to an average of 19 sessions to achieve a complete
recovery,
43
compared to 40 sessions using conventional treatments
alone.
5,46
This could lead to reduced hospital admissions for people
with diabetic ulcers and lighten the substantial public health and
socio-economic burden to our country. Further investigations are
necessary to obtain conclusive evidence of low-level laser in treating
diabetic foot ulcers in South Africa.
Acknowledgements
This work is based on research supported by the University of
Johannesburg and the South African Research Chairs Initiative of
the Department of Science and Technology and National Research
Foundation of South Africa (Grant No 98337). The authors thank
the National Laser Centre for the supply and servicing of lasers.
References
1.
Mbanya JCN, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan
Africa.
Lancet
2010;
375
: 2254–2266.
2.
International Diabetes Federation. Diabetes Atlas, 7th edn. Brussels: International
Diabetes Federation, 2015
3.
Rheeder P. Type 2 diabetes: the emerging epidemic.
S Afr Family Prac
2006;
48
(10): 20.
4.
Edmonds ME. Metabolic disorders. In: Lorimer D, Frowen P, O’Donnell M, Burrow
G.
Neal’s Disorders of the Foot
, 8th edn. Europe: Churchill Livingstone, 2010;
246–249.
5.
Minatel DG, Frade MAC, Franca SC, Enwemeka CS. Phototherapy promotes
healing of chronic diabetic leg ulcers that failed to respond to other therapies.
Laser Surg Med
2009;
41
: 433–441.
6.
Clarke A. Avoiding foot complications in diabetes.
Contin Med Ed
2010;
28
(4):
181–185.
7.
Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in
diabetes.
J Clin Invest
2007;
117
: 1219–1222.
8.
Cavanagh PR, Bus SA. Off-loading the diabetic foot for ulcer prevention and
healing.
J Vasc Surg
2010;
52
: 37S–43S.
9.
Bergin SM, Wraight PR, Burr JM. Australian diabetes foot network: management
of diabetes-related foot ulceration – a clinical update.
Med J Australia
2012;
197
:
226–229.
10. Guo S, Di Pietro LA. Factors affecting wound healing.
J Dent Res
2010;
89
(3):
219–229.
11. Jain AKC. A new classification of diabetic foot complications: a simple and
effective teaching tool.
J Diabetic Foot Complicat
2012;
4
(1): 1–5
12. Beckmann KH, Meyer-Hamme G, Schröder S. Low level laser therapy for the
treatment of diabetic foot ulcers: a critical survey.
Evidence-Based Comp Alt Med
2014
; 2014: 1–9.
13. Chadwick P, Edmonds M, McCardle J, Armstrong D. International best practice
guidelines: wound management in diabetic foot ulcers.
Wound Int
2013;
4
:
1–27.
14. Clarke EAM, Tsubane M. The role of a podiatrist in managing the diabetic foot
ulcer.
Wound Heal Sth Afr
2008;
1
(1): 40–42.
15. Kim PJ, Attinger CE, Evans KK. Role of a podiatrist in diabetic limb salvage.
J Vasc
Surg
2012;
56
: 1168–1172.
16. Houreld NN. Shedding light on a new treatment for diabetic wound healing: a
review of phototherapy.
Sci J
2014; 2014: 1–13.
17. Petrova N, Edmonds M. Emerging drugs for diabetic foot ulcer.
Expert Opin
Emerg Drugs
2006;
11
(4): 709–724.
18. Falanga V. Wound healing and its impairment in the diabetic foot.
Lancet
2005;
366
(9498): 1736–1743.
19. Clayton W, Elasy TA. A review of pathophysiology, classification and treatment of
foot ulcers in diabetic patients.
Clin Diabetes
2009;
27
(2): 52–58.
20. Bus SA, Valk GD, van Deursen RW,
et al.
The effectiveness of footwear and
offloading interventions to prevent and heal foot ulcers and reduce plantar
pressure in diabetes: a systematic review.
Diabetes Metab Res Rev
2008;
24
:
S162–S180.
21. Mueller MJ, Lott DJ, Hastings MK, Commean PK, Smith KE, Pilgram TK. Efficacy
and mechanism of orthotic devices to unload metatarsal heads in people with
diabetes and a history of plantar ulcers.
Phys Ther
2006;
86
(6): 833–842.
22. Tong JWK, Ng EYK. Preliminary investigation on the reduction of plantar loading
pressure with different insole materials (SRP – Slow Recovery Poron
®
, P – Poron
®
,
PPF – Poron
®
+ Plastazote, firm and PPS – Poron
®
+ Plastazote, soft).
Foot
2010;
20
: 1–6.
23. Sambrook E, Delpierre T, Bowen G. Advancing the gold standard in offloading the
diabetic foot: product evaluation.
Wounds UK EWMA Special
2015: 48–56.
24. Raspovic A, Landorf KB. A survey of offloading practices for diabetes-related
plantar neuropathic foot ulcers.
J Foot Ankle Res
2014;
7
: 35.
25. Fife CE, Carter MJ, Walker D. Why is it so hard to do the right thing in wound
care?
Wound Repair Regen
2010;
18
: 154–158.
26. Fife CE, Carter MJ, Walker D,
et al.
Diabetic foot ulcer offloading: the gap
between evidence and practice. Data from the US Wound Registry.
Adv Skin
Wound Care
2014;
27
: 310–316.
27. Armstrong DG, Wu S, Lavery LA, Boulton AJM. Evaluation of removable and
irremovable cast walkers in the healing of diabetic foot wounds: a randomized
controlled trial.
Diabetes Care
2005;
28
(3): 551–554.
28. Faglia E, Curci V,
et al.
Effectiveness of removable walker cast versus non-
removable fiberglass off-bearing cast in the healing of diabetic plantar foot ulcer:
a randomized controlled trial.
Diabetes Care
2010;
33
(7): 1419–1423.
29. Chadwick P, McCardle J, Cundell J, Towson M. Foot in Diabetes UK. The principle
of debridement: the diabetic foot. Developing Scope of Practice for Podiatrists in
the UK. 2014; 2014: 2–20.
30. Ahmad I, Akhtar S, Masoodi Z. Role of early radical debridement and skin cover
in diabetic foot ulceration.
J Wound Care
2012;
21
(9): 442–444, 446–447.
31. Williams D, Enoch S, Miller D, Harris K, Price P, Harding KG. Effect of sharp
debridement using curette on recalcitrant non-healing venous leg ulcers: A
concurrently controlled, prospective cohort study.
Wound Repair Regen
2005;
13
: 131–137.
32. Wolcott RD, Kennedy JP, Dowd SE. Regular debridement is the main tool for
maintaining a healthy wound bed in most chronic.
J Wound Care
2009;
18
(2):
55–56.
33. Cardinal M, Eisenbud DE, Armstrong DG,
et al.
Serial surgical debridement: a
retrospective study on clinical outcomes in chronic lower extremity wounds.
Wound Repair Regen
2009;
17
(3): 306–311.
34. Wilcox JR, Carter MJ, Covington S. Frequency of debridement and time to heal: a
retrospective cohort study of 312744 wounds.
J Am Med Assoc Dermatol
2013;
149
(9): 1050–1058.
35. Nteleki B, Houreld NN. The use of phototherapy in the treatment of diabetic
ulcers.
J Endocrin Metab Diabetes S Afr
2012;
17
(3): 128–132.
36. Dinh TL, Veves A. Treatment of diabetic ulcers.
Dermatol Ther
2006;
19
: 348–
355
37. Dyson M. Low level laser therapy, 2014. [article] Available from: http://www.
softlasers.com/low-level-laser-therapy-article.php.38. Houreld NN, Abrahamse H. Low intensity laser irradiation stimulates wound
healing in diabetic wounded fibroblast cells (WS1).
Diabetes Technol Ther
2010;
12
(12): 971–978.
39. Hamblin MR, Demidova TN. Mechanism of low level laser light therapy.
Proc SPIE
2006;
6140
(614001): 1605–7422.
40. Mokmeli S, Daemi M, Shirazi ZA, Shirazi FA, Hajizadeh M. Evaluating the efficiency
of low level laser therapy (LLLT) in combination with intravenous laser therapy
(IVL) on diabetic foot ulcer, added to conventional therapy.
Lasers Med Sci
2010;
1
: 8–13.
41. Enwemeka CS, Williams D, Hollosi S, Yens D. Blue light photo destroys methicillin-
resistant Staphylococcus aureus (MRSA) in vitro.
Photomed Laser Surg
2009;
27
(2): 221–226.
42. Kajagar BM, Godhi AS, Pandit A, Khatri S. Efficacy of low level laser therapy
on wound healing in patients with chronic diabetic foot ulcers – a randomised
control trial.
Indian J Surg
2012;
74
(5): 359–363.
43. Kazemi-Khoo N. Successful treatment of diabetic foot ulcers with low-level laser
therapy.
Foot
2006;
16
: 184–187.
44. Lipovsky A, Nitzan Y, Lubart R. A possible mechanism for visible light-induced
wound healing.
Lasers Surg Med
2008;
40
(7): 509–514.
45. Ankri R, Lubart R, Taitelbaum H. Estimation of the optimal wavelengths for laser
induced wound healing.
Lasers Surg Med
2010;
42
(8):760–764.
46. Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot
ulcers.
Lancet
2005;
366
: 1725–1735.