Extracorporeal shockwave therapy as a key component of interdisciplinary wound management in diabetic foot syndrome

BACKGROUND: A 57-year-old male patient presented with the first manifestation of severe type 2 diabetes mellitus in the setting of diabetic foot syndrome complicated by osteomyelitis. METHODS: The patient was treated conservatively within a multimodal interdisciplinary approach. In addition, focused extracorporeal shockwave therapy (fESWT) was performed according to International Society for Medical Shockwave Treatment (ISMST)-oriented principles. RESULTS: After five sessions of fESWT, local wound management resulted in extraction of a relevant bony sequestrum. Following sequestrum removal, a large wound cavity remained in the region of the right first toe (digitus I pedis), corresponding approximately to the size of an entire phalanx. Remarkably, within only 4 days, rapid and substantial granulation of the deep wound cavity was observed. CONCLUSION: The present case supports the hypothesis that focused ESWT may represent a clinically relevant adjunctive treatment option in selected patients with diabetic foot syndrome and complicated wound healing disorders. At the same time, it highlights the need for prospective randomized controlled trials.