Research Article
Interleukin-6 response to shock wave therapy versus polarized light therapy in the treatment of chronic diabetic foot ulcers Mahmoud H. Mohamed1*, Mohamed N. Selem2, Manar S. Mohamed3, Heba Ali Abd EL-Ghaffaar4 ABSTRACT Background: Diabetic foot is one of the most feared complications of diabetes mellitus (DM) characterized by definite inflammatory reaction as one of the DM complications. Foot ulcers are one of the danger complications among diabetic patients. The ulcers can be inflamed after the period of time and lead to pain and disability. The advancement of foot ulcer can cause amputation of lower limb. Purpose: The aim of this study was to investigate the response of interleukin 6 (IL-6) and ulcer surface area to shock wave therapy versus polarized light therapy in chronic diabetic foot ulcer. Materials and Methods: A total of 45 diabetic patients with chronic foot ulcer participated in the study, their age ranges from 55 to 65 years of age. They randomly assigned into three groups, Group A (15 patients) received shock wave and traditional wound care, Group B (15 patients) received polarized light therapy and traditional wound care, and Group C (controlled group) (15 patients) received traditional wound care only. Subjects were assessed pre and post 2 months of study. The foot ulcer is measured by planimeter method and IL-6 was measured by enzyme-linked immunosorbent assay. Results: The shock wave and polarized light therapy groups show significant improvement of foot ulcer surface area and lowering of IL-6 (P < 0.05) but not significant in controlled group (P < 0.05). Conclusion: Both polarized light therapy and shock wave therapy are effective in increasing the healing of diabetic foot ulcer and lowering of IL-6, but polarized light therapy is more effective than shock wave therapy in increasing the healing of diabetic foot ulcer and lowering of IL-6. KEY WORDS: Interleukin 6, Polarized light therapy, Shock wave
INTRODUCTION Diabetes mellitus (DM) is a complex metabolic disorder characterized by hyperglycemia, which results from either an absolute deficiency of insulin (Type 1 DM) or insulin resistance with or without abnormal insulin secretion (Type 2 DM [T2DM]). Approximately 90– 95% of individuals with diabetes suffer from T2DM.[1] The most common complication of diabetes is peripheral arterial disease and neuropathy, the patient complains of loss of sensation due to neuropathy and coldness in peripheral extremity due to ischemia. The combination of them will lead to foot ulcer.[2] The amputation is highly found in diabetic patient due to infection disease and increase risk of death[3] foot Access this article online Website: jprsolutions.info
ISSN: 0975-7619
ulcers occurred about 15% of patient with diabetes throughout their life with occurrence of 1–4%.[4] Altered blood circulation, ulcers, and amputations are the most common complication of diabetes. Diabetic foot ulcers lead to increased level of morbidity, disabled persons, cost of treatment, and high level of amputations. Most of lower extremity amputations are due to diabetes.[5] Many different factors will lead to diabetic foot ulcer, such as foot deformity, peripheral neuropathy, visual impairment, and arterial peripheral disease; all of these factors occur with high recurrence and severity in diabetic patient.[6] Pro- and anti-inflammatory mediators are important in the different phases of wound healing, as any changes in immune system can interfere with tissue homeostasis and delay wound healing. After the appearance of ulcers and persist for long time that can
Department of Physical Therapy for Integumentary, Faculty of Physical Therapy, Deraya University, Minia, Egypt, Department of Basic Science, Faculty of Physical Therapy, Beni-Suef University, Beni-Suef, Egypt, 3Department of Internal Medicine, Faculty of Physical Therapy, Deraya University, Minia, Egypt, 4Department of Physical Therapy for Cardiovascular, Respiratory Disorders and Geriatrics, Faculty of Physical Therapy, Cairo University, Egypt 1 2
*Corresponding author: Mahmoud H. Mohamed, Department of Physical Therapy for Integumentary, Faculty of Physical Therapy, Deraya University, Minia, Egypt. Email: mahmoud.hamada78@yahoo.com. Received on: 10-06-2019; Revised on: 16-07-2019; Accepted on: 17-08-2019 Drug Invention Today | Vol 11 • Issue 11 • 2019
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