Rapid Foot Ulcer Healing with Nitric Oxide Treatment
One of the hallmarks of diabetes is poor circulation. High blood sugar levels can cause damage to your blood vessels and can prevent a cut or open wound from healing properly. Poor circulation means that someone with diabetes can quickly develop a foot ulcer – a situation that can escalate into gangrene and the need to amputate the extremity if wound care doesn’t resolve the foot ulcer. Treatment is often not effective, so it’s good news that a research team may have found a quick, effective way to treat and heal foot ulcers in an individual with diabetes. In fact, diabetes foot ulcers are the most common foot injuries that lead to foot amputations.
On average, once a foot ulcer develops, it can take up to 150 days to completely heal. The biomedical engineers involved in this research found a way to harness the body’s own healing mechanism, amplifying levels of nitric oxide. Nitric acid levels are often impaired in patients with diabetes. In this case, utilizing bandages containing nitric oxide that release levels “as needed” seems to have solved this challenging medical treatment issue. The 2018 study published in MDPI-Medical Sciences showed that when nitric oxide is introduced and monitored closely, foot ulcer wound healing in a person with diabetes can be incredibly rapid and complete.
To understand how this new treatment can literally cut healing time to 21 days, you have to understand how wound healing occurs. Once you sustain an open wound in the skin, three types of cells step in to help with repair. Macrophages, arrive within 24 hours of the damage, helping to clear away debris. Fibroblasts are next on the scene, and they help to lay down the matrix necessary for the next cells to arrive. Those cells are keratinocytes and they are the cells that will do the actual rebuilding and repair or the wound, allowing it to ultimately close over time.
The role of nitric oxide, normally found in adequate levels in the body of a healthy person, is to “set the rhythm or pace” of the repair process by the different cells. It also helps to limit inflammation and induce cell proliferation and remodeling. It orchestrates a delicate balance, so just flooding the wound with more nitric oxide will not yield optimal results. The researchers found that the levels of nitric oxide have to be closely monitored and adjusted, based on the appearance of each of the three cell categories involved in wound repair.
This new process yielded the superior fast-track healing of 21 days, compared to the more typically observed 150 days of foot ulcer healing in a patient with diabetes.
One of the crucial elements of the research was the finding that you have to directly measure nitric oxide levels “in real time” and not nitrite levels, though stable nitrite is easier to measure. The researchers found that nitrite levels do not perfectly reflect the nitric oxide levels in the presence of high blood sugar. So, though it added a burden to the process, they found that they had to track and adjust nitric oxide levels directly. This close monitoring and adjusting of the nitric oxide levels nudged very rapid wound healing. The previous older method of just “adding nitric oxide” to bandages and assuming it would hasten wound healing simply doesn’t work in a meaningful way.
The research team plans to collaborate with a health system, in order to have access to more cell samples. This will allow them to test “personalized” bandages laden with specific amounts of nitric oxide, since patients obviously vary when it comes to their personal levels of nitric oxide. They can then create bandages that hold the amounts of nitric oxide that will match and compensate for the levels needed by an individual patient. They anticipate having those bandages ready-to-market in a year or less. The nitric oxide-releasing bandage could be a game-changer in the diabetes world, lowering rates of amputations and ensuring better quality of life for individuals with diabetes.
A cornerstone of diabetes is to prevent foot trauma and open wounds, in order to limit risk of a foot ulcer. Tips to do that include:
- Use protective footwear like wool socks that are breathable, indoors and outdoors (indoors with rubber treads to prevent slipping).
- Have a family member or friend help you to examine your feet regularly since diabetes-related nerve damage can result in skin numbness which may hinder your detection of a small abrasion or cut
- Keep feet clean and dry
- Have a health professional trim your toenails
- Make sure you have your shoes measured to avoid shoes that are too tight or too loose
- Check inside your shoes regularly to make sure they are not breaking down and developing sharp edges or seams
- See a podiatrist regularly
- If you do develop a wound or cut, seek medical attention immediately and comply with all wound care instructions
- Closely monitor and manage blood sugar levels
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