The feet of diabetic patients continue to be an unsolved problem in medicine. Uncontrolled neuropathy, ulceration and
infection usually lead to
amputation and presently there is no effective and reliable method that can be used to provide an efficient cure. Overall improvement in the salvage strategies, based on comprehensive pre-clinical evaluation,
debridement,
antibiotic therapy and follow up, has shown improvements in certain hospital settings, but the general picture for patients with
diabetic foot is to have some sort of
amputation, especially in underserved populations. It is clearly necessary to develop novel treatment strategies for this worldwide health problem.
Photodynamic therapy (
PDT) is a treatment modality that uses light to generate in situ
reactive oxygen species, which can cause cell death.
PDT can be used to treat several diseases, including foot
infections that do not respond well to
antibiotic therapy. There are several characteristics of
PDT that make it potentially ideal to treat
diabetic feet: the
photosensitizer is non-toxic in the dark, but after illumination it becomes a very efficient
antimicrobial agent with topical use, and it can regenerate small bones, such as the phalanges. However,
PDT is still not used in clinical practice to treat
diabetic feet. Therefore, we decided to perform a clinical study to prove that
PDT is an effective method to avoid
amputation of infected
diabetic feet. An inexpensive
PDT protocol was developed and applied to 18 patients with
osteomyelitis, classified as Grade 3 on the Wagner scale. Only one of these patients suffered
amputation. At least two of them were cured from resistant bacteria strains without intravenous
antibiotic therapy. In the control group of 16 patients, all of them ended up suffering
amputation. The rate of
amputation in the
PDT group was 0.029 times the rate in the control group and the difference is clearly statistically significant (p=0.002).