Low Level Light Therapy and Diabetic Foot Ulcer

NewsBot · Dec 21, 2022

Clinical Effect of Photobiomodulation on Wound Healing of Diabetic Foot Ulcers: Does Skin Color Needs to Be Considered?
Thabo Dhlamini and Nicolette Nadene Houreld
Volume 2022 | Article ID 3312840 | https://doi.org/10.1155/2022/3312840

Diabetic foot ulcers (DFUs) are one of the most common complications of diabetes. DFUs impede patients’ quality of life and are known to be unresponsive to conventional therapy. Photobiomodulation (PBM) is a pain-free, noninvasive treatment method that has been shown to promote chronic wound healing and has been successfully used for the treatment of DFUs. Since skin tone and color can affect the way light interacts with tissue, studies should take this into consideration when determining protocols for the use of PBM. This review is aimed at critically evaluating data of existing studies conducted to evaluate the clinical effect of PBM on DFUs, taking skin color into consideration. A literature search was conducted and resulted in articles on cell studies, animal studies, and clinical trials. Only 13 clinical trials and 2 clinical case studies were adopted and used in this review. All the clinical trials adopted for this review show evidence that PBM together with conventional treatment results in an increased healing rate of DFUs; however, only one study adjusted their protocol according to skin color. There are not enough studies conducted on people of color to determine the safety and efficacy of PBM therapy in such ethnic groups. Future randomized, placebo-controlled clinical trials are necessary on PBM and DFUs and should take skin color into consideration.
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NewsBot · Jan 19, 2023

Clinical Effect of Photobiomodulation on Wound Healing of Diabetic Foot Ulcers: Does Skin Color Needs to Be Considered?
Thabo Dhlamini , Nicolette Nadene Houreld
J Diabetes Res. 2022 Dec 17

Diabetic foot ulcers (DFUs) are one of the most common complications of diabetes. DFUs impede patients' quality of life and are known to be unresponsive to conventional therapy. Photobiomodulation (PBM) is a pain-free, noninvasive treatment method that has been shown to promote chronic wound healing and has been successfully used for the treatment of DFUs. Since skin tone and color can affect the way light interacts with tissue, studies should take this into consideration when determining protocols for the use of PBM. This review is aimed at critically evaluating data of existing studies conducted to evaluate the clinical effect of PBM on DFUs, taking skin color into consideration. A literature search was conducted and resulted in articles on cell studies, animal studies, and clinical trials. Only 13 clinical trials and 2 clinical case studies were adopted and used in this review. All the clinical trials adopted for this review show evidence that PBM together with conventional treatment results in an increased healing rate of DFUs; however, only one study adjusted their protocol according to skin color. There are not enough studies conducted on people of color to determine the safety and efficacy of PBM therapy in such ethnic groups. Future randomized, placebo-controlled clinical trials are necessary on PBM and DFUs and should take skin color into consideration.
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NewsBot · Jun 5, 2023

Dose-response relationship of photobiomodulation therapy and oxidative stress markers in healing dynamics of diabetic neuropathic ulcers in Wistar rats
Gagana Karkada et al
J Diabetes Metab Disord. 2022 Dec 22;22(1):393-400

Purpose: Diabetic foot ulcers are reported to be the most expensive complications of diabetes, with high morbidity and mortality rates. If the necessary care is not provided for the wound to heal, the individual may end up amputating the affected feet. Photobiomodulation therapy is a promising non-pharmacological treatment option for wound healing. The objective of the present study is to establish a dose-response relationship between photobiomodulation therapy and oxidative stress markers in the healing dynamics of diabetic neuropathic ulcers in Wistar rats.

Methodology: Diabetic neuropathy was induced in 126 Albino Wistar rats. An excisional wound of an area of 2cm2 was made on the neuropathy-induced leg. Photobiomodulation therapy of dosages 4, 6, 8, 10, 12, and 15 J/cm2 of wavelengths 655 and 808 nm was irradiated. The control group animals were kept un-irradiated. The outcome measures were assessed during wound healing's inflammatory, proliferative and remodelling phases.

Results: In the experimental group, animals treated with photobiomodulation therapy at doses of 4, 6, and 8 J/cm2 showed better wound healing dynamics. Photobiomodulation therapy modulated the reactive oxygen species and antioxidant levels, thereby improving the oxidative status of the wound.

Conclusion: Photobiomodulation therapy of dosages 4, 6, and 8 J/cm2 is effective and is a promising adjuvant modality in treating diabetic neuropathic ulcers. There was a strong dose-response relationship in the experimental groups treated with 4, 6 and 8 J/ cm2.
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NewsBot · Jul 25, 2023

Electromechanical therapy in diabetic foot ulcers patients: A systematic review and meta-analysis
Ayeshmanthe Rathnayake, Apoorva Saboo, Venkat Vangaveti & Usman Malabu
Journal of Diabetes & Metabolic Disorders (2023)

Purpose
Diabetic foot ulcer (DFU) is one of the most devastating and troublesome consequences of diabetes. The current therapies are not always effective because of the complicated aetiology and interactions of local and systemic components in DFU. However, adjunctive therapy (electromechanical therapy) has become the latest modality in recent years, although there is a lack of significant research to support its utilization as a treatment standard. The purpose of this systematic research was to review the literature on the application of electromechanical therapies in the healing of DFUs.

Methods
For this systematic review, we searched PubMed, Medline, EmBase, the Cochrane library, and Google Scholar for the most current research (1990–2022) on electromechanical therapies for DFUs. We used the PICO method (where P is population, I is intervention, C is comparator/control, and O is outcome for our study) to establish research question with the terms [Electromechanical therapy OR Laser therapy OR photo therapy OR Ultrasound therapy OR Shockwave therapy] AND [diabetic foot ulcers OR diabetes] were used as search criteria. Searches were restricted to English language articles only. Whereas, Cochrane handbook of “Systematic Reviews of Interventions” with critical appraisal for medical and health sciences checklist for systematic review was used for risk of bias assessment. There were 39 publications in this study that were deemed to be acceptable. All the suitably selected studies include 1779 patients.

Results
The meta-analysis of 15 included research articles showed the overall effect was significant (P = 0.0002) thus supporting experimental groups have improvement in the DFUs healing in comparison to the control group.

Conclusion
This systematic review and meta-analysis revealed electromechanical treatments are significantly viable options for patients with DFUs. Electromechanical therapy can considerably reduce treatment ineffectiveness, accelerate healing, and minimize the time it takes for complete ulcer healing.
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NewsBot · Jul 27, 2023

Efficacy of microcurrent therapy versus laser therapy for diabetic foot ulcer on size of the wound
Kamalakannan M. et al
Source

Introduction and Aim: Diabetes mellitus (DM) will increasingly contribute to years of life and disability worldwide. Approximately 25% of individuals with diabetes will develop diabetic foot ulcers. This study aimed to assess the effectiveness of microcurrent therapy compared to low-level laser therapy in terms of wound healing and quality of life among patients with diabetic foot ulcers.

Materials and Methods: This study followed a prospective randomized open blinded endpoint assessment (PROBE) design with two parallel groups allocated in a 1:1 ratio. Participants meeting the selection criteria and having diabetic foot ulcers were included. Baseline measurements were taken before randomly assigning participants to the treatment groups. Pre-test and post-test data were collected to evaluate the wound size.

Results: The t-test analyses demonstrated significant improvement in both treatment groups (LLLT: t = 41.818, p < 0.001; Micro-Current Group: t = 32.787, p < 0.001). To compare the groups, One-Way Analysis of Variance (ANOVA) was conducted, indicating a significant difference in ulcer size between the LLLT group (mean value: 62.600, SD=3.035) and the microcurrent therapy group (mean value: 51.933, SD= 6.938).

Conclusion: This study concludes that microcurrent therapy is more effective than low-level laser therapy for managing diabetic foot ulcers. The findings suggest that a 3-week intensive physiotherapy therapeutic approach, combined with conventional medical treatment, yields the best results in terms of wound healing.
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NewsBot · Aug 22, 2023

Diabetic foot wound ulcer management by laser therapy: A meta-analysis
He Liu, Xia Ya-Qing, Yang Cai-Feng, He Jia-Li, Tang Xian-Yu
18 August 2023 https://doi.org/10.1111/iwj.14320

A meta-analysis examination was implemented to review diabetic foot wound ulcer (DFWU) management by laser therapy (LT). A broad literature examination until May 2023 was done and 1357 interconnected examinations were revised. The 26 elected examinations, enclosed 1067 personals with DFWU were in the utilized examinations ‘starting point, 540 of them were utilizing LT, and 527 were utilizing control. Odds ratio (OR) and 95% confidence intervals (CIs) were utilized to appraise the DFWUs management by LT by the dichotomous and continuous approach and a fixed or random model. LT had significantly higher ulcer size decreases (MD, 17.04; 95% CI, 12.48–21.59, p < 0.001) with high heterogeneity (I2 = 99%), and complete healing rate (OR, 2.88; 95% CI, 1.89–4.37, p < 0.001) with no heterogeneity (I2 = 0%) compared with control in personals with DFWU. LT had significantly higher ulcer size decreases, and complete healing rate compared to control in personals with DFWU. Nevertheless, exercise caution while interacting with its values since all the chosen examinations were found with a low sample size for the comparisons in the meta-analysis
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NewsBot · Apr 13, 2024

Effects of Photobiomodulation Therapy on the Expression of Hypoxic Inducible Factor, Vascular Endothelial Growth Factor, and Its Specific Receptor: A Randomized Control Trial in Patients with Diabetic Foot Ulcer
Giti Torkaman et al
Photobiomodul Photomed Laser Surg. 2024 Mar 27

Background: Impaired angiogenesis is a significant factor contributing to delayed healing in diabetic foot ulcers (DFUs) due to inadequate oxygenation. Objective: This study aimed to investigate the impact of photobiomodulation (PBM) using a Ga-As laser on the release of serum hypoxia-inducible factor 1-α (HIF-1α), vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor-2, and nitric oxide (NO) in diabetic patients with DFUs. Materials and methods: In this double-blind RCT, a total of 30 patients with grade II DFUs were enrolled. The patients were randomly divided into two groups: the PBM (n = 15) and the placebo (n = 15). In the PBM group, a Ga-As laser (904 nm, 2 J/cm2, 90 W) was given for 3 days/week for 4 weeks (11 sessions). In the placebo group, the power was turned off. Both groups received similar standard wound care. Before and after interventions, the levels of serum HIF-1α, VEGF, NO, and sVEGFR-2 were measured. In addition, the percentage decrease in the wound surface area (%DWSA) was measured. Results: Following the intervention, the results revealed that the PBM group had significantly lower levels of VEGF than the placebo group (p = 0.005). The %DWSA was significantly higher in the PBM group compared to the placebo group (p = 0.003). Moreover, VEGF showed a significant negative correlation with %DWSA (p < 0.001). Conclusions: The observed decrease in serum levels of VEGF and an increase in %DWSA, compared to the placebo group, suggests that PBM effectively improves angiogenesis. Furthermore, the significant correlation found between VEGF levels and %DWSA emphasizes the importance of evaluating wound surface in patients as a dependable indicator of enhanced wound angiogenesis.
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NewsBot · May 29, 2024

Dose-response and efficacy of 904 nm photobiomodulation on diabetic foot ulcers healing: a randomized controlled trial
Vinicius Saura Cardoso et al
Lasers Med Sci. 2024 May 28;39(1):142

Purpose: This study aimed to examine the impact of a 904 nm photobiomodulation (PBM) on diabetic ulcers using varying dosages.

Methods: The study was a randomized, double-blind, placebo-controlled clinical trial that compared treatments using PBM (GaAs 904 nm 30w) with three different energy densities (4 J/cm2; 8 J/cm2; 10 J/cm2) in the healing process of non-infected diabetic foot ulcers. Eighty volunteers (48.75% female; 58.5 ± 11.1 years) were randomized into three intervention groups treated with PBM and one control group (PBM placebo). Volunteers performed up 20 interventions with PBM, either placebo or actual, in conjunction with conventional therapy, which involved dressing the wound with Helianthus annuus vegetable oil. The primary variable was the ulcer size reduction rate.

Results: GaAs 904 nm PBM yielded a clinically and significant ulcer size rate reduction of diabetic foot ulcers, independently of energy density range (p < 0.05). However, 10 J/cm² had 60% of completely healed ulcers and the highest proportion of patients reaching 50% of ulcer reduction rate after 5 weeks of treatment. In addition, only 10 J/cm² showed a significant difference between control group after a 10-week follow-up (p < 0.05).

Conclusion: GaAs 904 nm PBM was effective in treating diabetic foot ulcers in this study and a dosage of 10 J/cm², after a 10-week follow-up, proved to be the most effective compared to the other groups.
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NewsBot · Jul 17, 2024

Low-Level Laser Therapy (LLLT) for Diabetic Foot Ulcer in Uncontrolled Diabetes: A Case Report of Improved Wound Healing
Yose Waluyo, Muhammad Syairozi Hidayat
Am J Case Rep. 2024 Jul 3:25:e944106

BACKGROUND Diabetes mellitus (DM) is one of the most prevalent diseases worldwide and is associated with increased morbidity and mortality. One of the microvascular complications of DM is diabetic foot ulcer (DFU), which is associated with increased mortality from serious infections and decreased functional capacity of the patient due to amputation. Uncontrolled diabetes is a significant risk factor for poor wound healing. There is a need for alternative treatments that can promote wound healing in these patients. Several studies have shown the effect of low-level laser therapy (LLLT) on wound healing in patients with DFU. LLLT is a potential therapeutic approach in patients with DFU. CASE REPORT A 55-year-old male patient presented with a history of DM, diabetic neuropathy, and diabetic foot. The patient had uncontrolled blood sugar levels, with an HbA1C of 9.3%. The patient received therapy in the form of wound care with normal saline, topical antibiotics, and LLLT, with a dose of 10 J/cm² with a frequency of therapy 3 times per week. After 12 weeks of therapy, there was improvement, characterized by wound tissue growth and no significant adverse effects during therapy. CONCLUSIONS LLLT can provide benefits in patients with DFU and uncontrolled diabetes. The wound showed improvement after 12 weeks of therapy, and there were no significant adverse effects during therapy. LLLT is a minimally invasive, easy-to-use, and inexpensive therapeutic option to induce wound healing in patients with DFU and uncontrolled diabetes.
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NewsBot · Jul 25, 2024

Effect of Using Photobiomodulation (660 Nanometers) for the Treatment of Diabetic Ulcers: Protocol for a Randomized Controlled Trial
Mariana Bezerra Miranda et al
Int J Low Extrem Wounds. 2024 Jul 21

Diabetic foot ulcers (DFUs) result in tissue damage or impairment of deeper structures that affect quality of life. The impacts are numerous, and even after a long treatment period, 65% of patients experience recurrence. Among the interventions used to accelerate the healing process of DFUs, photobiomodulation therapy (PBMT) is a painless, noninvasive, and low-cost treatment. To achieve effective therapeutic results optimal PBMT parameters are necessary. The positive effect of PBMT on diabetic cells may be dependent on fluence (J/cm2) and wavelength (nm). This double-blind, randomized clinical trial will be conducted at the University Clinic of Physical Therapy. One hundred patients will be randomly placed in 4 groups. A Laserpulse Ibramed (Helium-Neon, HeNe, 660 nm) with 20 W power will be used (continuous mode), with doses stipulated for each treatment group (GL1, 4 J/cm2; GL2, 8 J/cm2; GL3, 12 J/cm2) and Endophoton KLD GaAs 904 nm (ST, 10 J/cm2) for 2 nonconsecutive days per week for 10 weeks, for a total of 20 sessions. The primary outcomes will be ulcer healing rate and University of Texas classification scores. Patients' DFUs will be assessed on the 1st day, 5 weeks, and 10 weeks of treatment then 1 month after the end of treatment. This study may aid effective clinical decision-making for the management of DFUs.
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NewsBot · Jul 27, 2024

Exploring Photobiomodulation Therapy and Regenerative Medicine for Diabetic Foot Ulcers: Pathogenesis and Multidisciplinary Treatment Approach
Elahe Torabi et al.
J Lasers Med Sci. 2024 Jun 29:15

Introduction: Diabetes is associated with several debilitating complications, including the development of diabetic foot ulcers (DFUs), which can have serious consequences. This study emphasizes a multidisciplinary approach, providing a thorough overview of DFU pathogenesis and available treatments. Methods: An extensive literature review, covering studies published between 2000 and 2023, was conducted to gather data on DFU pathophysiology and treatments, including wound dressings, photobiomodulation, off-loading devices, adjunct medicines, and stem cell therapy. Results: DFUs are complicated due to infection, ischemia, and neuropathy. Sufficient wound dressings maintain a moist environment, promoting autolytic debridement and facilitating the healing process. Through cellular mechanisms, photobiomodulation therapy (PBM) was observed to expedite the healing process. Additionally, off-loading devices were invented to reduce ulcer pressure and promote healing. Adjunct therapies such as negative pressure wound therapy and hyperbaric oxygen therapy were identified as valuable tools for enhancing healing outcomes. Furthermore, autologous and allogeneic stem cell treatments exhibited the potential for promoting tissue regeneration and expediting the healing process. Conclusion: The complex pathophysiology of DFUs necessitates a multimodal treatment approach. Essential components include PBM, wound dressings, off-loading devices, adjunct treatments, and stem cell therapy.
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NewsBot · Jul 28, 2024

Adherence to Self-care and Quality of Life of Patients with Diabetic Foot Ulcers Treated with Low-Level Laser Therapy: An Exploratory Study
Cristiana Maria Dos Santos et al
Adv Skin Wound Care. 2024 Aug 1;37(8):1-10

Objective: To evaluate the quality of life (QoL) of patients with a diabetic foot ulcer undergoing treatment with low-level laser therapy (LLLT) at 904 nm and its association with self-care.

Methods: In this randomized, exploratory study, participants were divided into the following four groups: control group (CG) with LLLT placebo, LLLT group 1 (LG1) at 10 J/cm2, LLLT group 2 (LG2) at 8 J/cm2, and LLLT group 3 (LG3) at 4 J/cm2. Participants received light therapy (or placebo) twice a week, for a total of 20 sessions. Researchers assessed participants' QoL using the Short-Form 36 questionnaire.

Results: Sixty-two participants were included in the analysis (CG = 18, LG1 = 14, LG2 = 17, LG3 = 13). The LG1 group showed a higher proportion of healing, whereas the CG group showed a lower proportion than the other groups. The LG1 group showed a relationship between physical limitations and blood glucose monitoring, pain and foot care, and general health status (GHS) and foot care. The GL2 group showed a relationship between physical limitations and blood glucose monitoring, vitality and foot care, and GHS and diet.

Conclusions: Low-level laser therapy had a positive impact on QoL as assessed by the Short-Form 36 questionnaire (functional capacity, vitality, and pain domains), and there was a positive association between QoL and self-care in the LLLT groups (physical limitations, pain, GHS, and vitality domains).
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NewsBot · Jul 30, 2024

Effect of Visible and Infrared Photobiomodulation on Diabetic Foot Ulcers
Faraj Tabeie et al
J Lasers Med Sci. 2024 May 15:15:e12

Introduction: Diabetes is a highly prevalent disease worldwide. Despite routine treatments, there is no effective treatment approach for patients with diabetic foot ulcers (DFUs). A new approach to reduce complications and control DFU is low-level laser therapy (LLLT). In the present study, we evaluated the therapeutic effects of LLLT on the symptoms of DFU patients. Methods: Sixty diabetic patients with DFU were included in this randomized clinical trial and were randomly allocated into two groups of laser (n=30) and control (n=30) with signed written consent. The LLLT group underwent visible and infra-red laser therapy and conventional medical treatment, while the control group received only conventional medical treatment. The total laser irradiation sessions of the patients were 20 sessions, (three sessions a week) and each session lasted for 30 minutes over the entire surface of the wound. The power density per session for each laser was calculated to be 35.65 mW/cm2 with an energy density of 64.17 J/cm2. Results: The mean area of ulcers in the LLLT group reduced significantly (P<0.001) from 441.7±365.5 mm2 before LLLT to 163.9±213.9 mm2 from the baseline up to the last session of LLLT, indicating a 62.99% reduction in mean ulcer area. In the control group, the mean ulcer area did not change significantly. Wagner's classification of the patients in the LLLT group reduced to lower grades significantly (P<0.01), while the classification moved towards higher grades in the control group (P<0.08). Conclusion: In this study, we showed the effectiveness of LLLT in the reduction of the surface and depth of DFUs. The results documented that patients experienced significant improvements in the healing of their foot ulcers after laser therapy. It is recommended that the LLLT be considered as a non-invasive method for the treatment of DFU patients.
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NewsBot · Aug 28, 2024

A Case Report: The Effects of Photobiomodulation Therapy and Amniotic Fluid Gel on a Severe Diabetic Foot Ulcer
Elahe Motamedi Nasab et al
J Lasers Med Sci. 2024 Jul 27:15:e25

Introduction: Diabetic patients frequently experience a serious complication known as impaired wound healing, which increases the likelihood of foot infection and limb amputation. Investigators have been looking for novel methods to treat diabetic foot ulcers (DFUs) recently. Case Report: A 75-year-old woman with type one diabetes mellitus (DM) has been accepted. There was a sizable (40 cm2 full-thickness cutaneous wound) in the plantar part of her right foot (Wagner Ulcer Grade Classification System: grade 3) which had not been treated by the usual treatment for DFUs. In this present case, we used amniotic fluid gel (AF gel) and photobiomodulation therapy (PBMT) (400 mW/cm2; 810 nm, once a week for 16 weeks) to treat and speed up the healing of a harsh DFU. The size of the ulcer area significantly decreased as combination therapy progressed, and within 16 weeks, the wound was healed and the pain was reduced. Conclusion: This revealed contextual analysis demonstrated the useful effect of the mix of PBMT and AF gel on a serious DFU. To confirm the findings, we recommend conducting additional clinical trials in a clinical setting. In addition, it is recommended that additional research using preclinical models uncover the mechanism of action of the combination therapy.
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NewsBot · Oct 1, 2024

Efficacy and safety of red and infrared light in the adjunctive treatment on diabetic foot ulcers: A systematic review and meta-analysis
Jing Zhang et al
Complement Ther Clin Pract. 2024 Sep 11

Background: The use of various adjunctive phototherapies for diabetic foot ulcers (DFUs) makes it difficult to fully understand their roles in current laser-based review studies. Red and infrared light have significant advantages for wound healing. To evaluate the impact of red and infrared light on the healing of DFUs and provide evidence-based recommendations for future clinical adjunctive treatments of DFUs.

Methods: Multiple databases, including PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, PEDro, CNKI, CBM, Wanfang, and VIP, were systematically searched for articles published until November 2023. The focus of the search was to identify randomised controlled trials that investigated the effects of red and infrared light on the treatment of DFUs. Data extraction, literature screening, and methodological quality assessment were conducted independently by two researchers. A meta-analysis was performed using RevMan5.4 and STATA16.0 software.

Results: A total of 28 studies, involving 1471 patients, were included. The meta-analysis showed that groups treated with red and infrared light had a significantly higher ulcer healing rate [risk ratio (RR) = 1.93, 95 % confidence interval (CI) (1.63, 2.28), P < 0.00001], shorter ulcer healing time [mean difference (MD) = 18.52, 95 % CI (8.58, 28.47), P < 0.00001], increased peak blood flow velocity in the dorsalis pedis artery [mean difference (MD) = 6.54, 95 % CI (4.01,9.08)], P < 0.00001), and reduced wound pain score [mean difference (MD) = -4.33, 95 % CI (-4.94, -3.71)], P < 0.00001) compared to the control group. However, there was no statistically significant difference in the incidence of adverse events [odds ratio (OR) = 0.32, 95 % CI (0.09, 1.17), P = 0.08] between the two methods.

Conclusion: The use of red and infrared light as an adjunctive treatment for DFUs is more beneficial than conventional wound care. However, due to limitations in the quality and sample size of the included studies, further high-quality research is needed to validate these conclusions.
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Low Level Light Therapy and Diabetic Foot Ulcer

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Low Level Laser for Diabetic neuropathy

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Low Level Light Therapy and Diabetic Foot Ulcer

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Who can do low level footcare ie cut toenails,corns,hard skin etc in Oz

Low Level Laser for Diabetic neuropathy

Low testosterone levels and pins & needles??

Low level laser therapy

Low Noise Level Drill

Low Level Laser and Fungal nails

Low level laser therapy V Ultrasound

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