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A Comprehensive Review on Diagnosis and Management of Diabetic Foot Ulcers with Possible Ayurvedic and Herbal Remedies

Year 2023, Volume: 43 Issue: 2, 185 - 194, 01.06.2023
https://doi.org/10.52794/hujpharm.1167357

Abstract

Diabetes, a silent killer and globally renowned disease, has enormously afflicted most parts of the world causing serious health issues to an individual. The aetiology of these ulcers includes high glucose levels, improper foot hygiene, etc. The pathophysiology of diabetic foot ulcers involves oxidative stress to the nerve tissues and other complications leading to loss of sensation in the patient’s feet. Many times, diabetes remains undiagnosed but the foot ulcers can be evaluated by the latest electro-diagnostic, radiological, or vascular studies. Once identified, they can be treated with several topical antibiotics and certain foot assistance methods. Besides allopathic medication, a large number of medicinal plants and phytochemicals are commonly employed as supportive therapy which possesses anti-oxidant, anti-bacterial, and other potent therapeutic properties enhancing the wound healing process as per its physiology and with minimal side effects. Ayurvedic formulations are also widely used in the treatment of diabetic foot wounds. Therefore, the present review aims to address the most commonly used diagnostic methods as well as the treatment of diabetic foot wounds. The article specifically reviews herbal plants Phellodendron chinense, Angelica dahurica, and Moringa oleifera and Ayurvedic formulations like Jatyadi Ghrita and Triphala for their effectiveness in treating diabetic foot remission.

Supporting Institution

NA

Project Number

NA

Thanks

NA

References

  • Frequently Asked Questions: Diabetic Foot Ulcers, Michigan Medicine.; [cited 2022 August 8]. Available from: https://www.uofmhealth.org/conditions-treatments/podiatry-foot-care/frequently-asked-questions-diabetic-foot-ulcers [Website]
  • Diabetic foot ulcer.; [cited 2022 August 13]. Available from: https://toticell.com/diabetic-foot-ulcer [Website]
  • Diabetic Foot Ulcers.; [2022 August 13]. Available from: https://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causes-treatments [Website]
  • Kuo YS, Chien HF, Lu W. Plectranthus amboinicus and Centella asiatica Cream for the Treatment of Diabetic Foot Ulcers. Evid Based Complement Alternat Med. 2012;2012:1–9.
  • Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention, diagnosis and classification. Am Fam Physician. 1998;57(6):1325–32, 1337–8.
  • Shah P, Inturi R, Anne D, Jadhav D, Viswambharan V, Khadilkar R, et al. Wagner’s Classification as a Tool for Treating Diabetic Foot Ulcers: Our Observations at a Suburban Teaching Hospital. Cureus [Internet]. 2022 Jan 22 [cited 2023 May 20]; Available from: https://www.cureus.com/articles/82780-wagners-classification-as-a-tool-for-treating-diabetic-foot-ulcers-our-observations-at-a-suburban-teaching-hospital
  • Diabetic Foot Ulcers- Symptoms, Causes, and Risk Factors - Pristyn Care: [cited 2022 August 15]. Available from: https://www.pristyncare.com/blog/diabetic-foot-ulcers-symptoms-causes-risk-factors-pc0441/ [Website]
  • Rosyid FN. Etiology, pathophysiology, diagnosis and management of diabetics’ foot ulcer. Int J Res Med Sci. 2017;5(10):4206.
  • Neuropathic Ulcer.: [cited 2022 August 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559214/ [Website]
  • Aumiller WD, Dollahite HA. Pathogenesis and management of diabetic foot ulcers. JAAPA 2015;28(5):28–34.
  • Clayton W, Elasy TA. A Review of the Pathophysiology, Classification, and Treatment of Foot Ulcers in Diabetic Patients. Clin Diabetes. 2009;27(2):52–8.
  • Bharara M, Cobb JE, Claremont DJ. Thermography and Thermometry in the Assessment of Diabetic Neuropathic Foot: A Case for Furthering the Role of Thermal Techniques. Int J Low Extrem Wound. 2006;5(4):250–60.
  • Ankle-Brachial Index Use in Patients with Diabetes : Advances in Skin & Wound Care.: [cited 2022 August 14]. Available from https://journals.lww.com/aswcjournal/Citation/2004/04000/Ankle_Brachial_Index_Use_in_Patients_with_Diabetes.8.aspx [Website]
  • Lam K, van Asten SAV, Nguyen T, La Fontaine J, Lavery LA. Diagnostic Accuracy of Probe to Bone to Detect Osteomyelitis in the Diabetic Foot: A Systematic Review. Clin Infect Dis. 2016;63(7):944–8.
  • Plassmann P, Monitoring chronic wounds and determining treatment. Farrar. D. UK: Advanced Wound Repair Therapies, Woodhead Publishing, 2011, pp. 130–152.
  • Tornow M, Kaszubiak J, Kuhn R, Michaelis B, Schindler T. Hardware Approach for Real Time Machine Stereo Vision. Int J Syst Cybern Inform. 2005;4.
  • Pena G, Kuang B, Szpak Z, Cowled P, Dawson J, Fitridge R. Evaluation of a Novel Three-Dimensional Wound Measurement Device for Assessment of Diabetic Foot Ulcers. Adv Wound Caref. 2020;9(11):623–31.
  • Pappachan JM, Cassidy B, Fernandez CJ, Chandrabalan V, Yap MH. The role of artificial intelligence technology in the care of diabetic foot ulcers: the past, the present, and the future. World J Diabetes. 2022;13(12):1131–9.
  • Nather A, Cao S, Chen JLW, Low AY. Prevention of diabetic foot complications. Singapore Med J. 2018;59(6):291–4.
  • Najafi B, Reeves ND, Armstrong DG. Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer‐free days in remission. Diabetes Metab Res Rev. 2020: 36 Suppl 1, e3239.Zhang X na, Ma Z
  • Zjun, Wang Y, Sun B, Guo X, Pan C qing, et al. Angelica Dahurica ethanolic extract improves impaired wound healing by activating angiogenesis in diabetes. Caporali A, editor. PLoS ONE. 2017;12(5):e0177862.
  • Everett E, Mathioudakis N. Update on management of diabetic foot ulcers: Diabetic foot ulcers. Ann NY Acad Sci. 2018;1411(1):153–65.
  • Tchanque‐Fossuo CN, Ho D, Dahle SE, Koo E, Li C, Isseroff RR, et al. A systematic review of low‐level light therapy for treatment of diabetic foot ulcer. Wound Rep and Reg. 2016;24(2):418–26.
  • Karkada G, Maiya GA, Arany P, Rao M, Adiga S, Kamath SU. Effect of Photobiomodulation Therapy on Oxidative Stress Markers in Healing Dynamics of Diabetic Neuropathic Wounds in Wistar Rats. Cell Biochem Biophys. 2022;80(1):151–60.
  • Wound Care Dressing – Maxiocel.: [cited 2022 August 16]. Available from: https://axiobio.com/maxiocel/wound-care-dressing/ [Website]
  • Maxiocel – 100% Chitosan Wound Dressing on Diabetic Foot Infection (Amputation).: [cited 2022 August 14]. Available from: https://axiobio.com/uploads/pdf/maxiocel/diabetic-foot-infection-amputation-case-study-6-maxiocel.pdf [Website]
  • Maxiocel – 100% Chitosan Wound Dressing on Diabetic Foot Infection (Amputation).: 2022 August 14. Available from: https://axiobio.com/uploads/pdf/maxiocel/diabetic-foot-infection-amputation-case-study-6-maxiocel.pdf [Website]
  • Heuch L, Streak Gomersall J. Effectiveness of offloading methods in preventing primary diabetic foot ulcers in adults with diabetes: a systematic review. JBI Database Syst Rev Implement. 2016;14(7):236–65.
  • Oguntibeju OO. Medicinal plants and their effects on diabetic wound healing. Vet World. 2019;12(5):653–63.
  • Jia H, Yang B, Li Y, Liang C, Lu H, Lin D, et al. Chinese medicine ulcer oil promotes the healing of diabetic foot ulcers. J Int Med Res. 2018;46(7):2679–86.
  • Sun Y, Lenon GB, Yang AWH. Phellodendri Cortex: A Phytochemical, Pharmacological, and Pharmacokinetic Review. Evid Based Complement Alternat Med. 2019;2019:1–45.
  • Xiong Y, Huang H, Li Y, Jiang G, Du L. Effect of Yinhuangsan (YHS) on Diabetic Foot Ulcers (DFU): A Systematic Review and Meta-Analysis. J Diabetes. 2021;11(03):97–114.
  • Liu Y, Li Y, Du Y, Huang T, Zhu C. Multicenter Clinical Trials Analyzing Efficacy and Safety of Topical Cortex Phellodendri Compound Fluid in Treatment of Diabetic Foot Ulcers. Med Sci Monit [Internet]. 2020 Jun 19 [cited 2023 May 20];26. Available from: https://www.medscimonit.com/abstract/index/idArt/923424
  • Lee K, Shin MS, Ham I, Choi HY. Investigation of the mechanisms of Angelica dahurica root extract-induced vasorelaxation in isolated rat aortic rings. BMC Complement Altern Med. 2015;15(1):395.
  • Guo J, Hu Z, Yan F, Lei S, Li T, Li X, et al. Angelica dahurica promoted angiogenesis and accelerated wound healing in db/db mice via the HIF-1α/PDGF-β signaling pathway. Free Radic Biol Med. 2020;160:447–57.
  • Babu Natarajan S, Das SK, Chandran SP, Myo Oo A, Kanneppady SS, Entezarian M, et al. Moringa oleifera leaf extract loaded hydrogel for diabetic wound healing. Malaysian J Med Res. 2018;2(2):35–41.
  • Amali Muhammad A, Fakurazi S, Arulselvan P, See CP, Abas F. Evaluation of wound healing properties of bioactive aqueous fraction from Moringa oleifera Lam on experimentally induced diabetic animal model. Drug Des Devel Ther. 2016;1715.
  • Gupta R, Mathur M, Bajaj VK, Katariya P, Yadav S, Kamal R, et al. Evaluation of antidiabetic and antioxidant activity of Moringa oleifera in experimental diabetes: Antidiabetic activity of M. oleifera. J. Diabetes. 2012;4(2):164–71.
  • Kulkarni Y, Emmi S, Dongargaon T, Wali A. Wound healing effect of Vimlāpanakarma with Jātyādi tailam in diabetic foot. Ancient Sci Life. 2015;34(3):171.
  • Dhande P, Simpy R, Nargis I, Sanghavi D, Vijaya A. Burn wound healing potential of Jatyadi formulations in rats. Res J Pharm Biol Chem Sci. 2012;3:747–54.
  • Jose A, Adiga S, Ciraj A, Shettigar K, Velladath S, Ramachandra L. Management of grade IV diabetic foot ulcer by vrana ropana chikitsa: A case study. J Med Sci. 2021;0(0):0.
  • Lim JZM, Ng NSL, Thomas C. Prevention and treatment of diabetic foot ulcers. J R Soc Med. 2017;110(3):104–9.
  • Manning L, Hamilton EJ, Raby E, Norman PE, Davis W, Wood F, et al. Spray on skin for diabetic foot ulcers: an open label randomised controlled trial. J Foot Ankle Res. 2019;12(1):52.
  • Aerosol images.: [cited 22 August 2022]. Available from: https://www.pngwing.com/en/free-png-zeqnb [Website]
  • Pharmaceutical aerosol – uses and advantages.: [cited 2022 August 22]. Available from: http://pharmabiz.com/NewsDetails.aspx?aid=113171&sid=9 [Website]

A Comprehensive Review on Diagnosis and Management of Diabetic Foot Ulcers with Possible Ayurvedic and Herbal Remedies

Year 2023, Volume: 43 Issue: 2, 185 - 194, 01.06.2023
https://doi.org/10.52794/hujpharm.1167357

Abstract

Diabetes, a silent killer and globally renowned disease, has enormously afflicted most parts of the world causing serious health issues to an individual. The aetiology of these ulcers includes high glucose levels, improper foot hygiene, etc. The pathophysiology of diabetic foot ulcers involves oxidative stress to the nerve tissues and other complications leading to loss of sensation in the patient’s feet. Many times, diabetes remains undiagnosed but the foot ulcers can be evaluated by the latest electro-diagnostic, radiological, or vascular studies. Once identified, they can be treated with several topical antibiotics and certain foot assistance methods. Besides allopathic medication, a large number of medicinal plants and phytochemicals are commonly employed as supportive therapy which possesses anti-oxidant, anti-bacterial, and other potent therapeutic properties enhancing the wound healing process as per its physiology and with minimal side effects. Ayurvedic formulations are also widely used in the treatment of diabetic foot wounds. Therefore, the present review aims to address the most commonly used diagnostic methods as well as the treatment of diabetic foot wounds. The article specifically reviews herbal plants Phellodendron chinense, Angelica dahurica, and Moringa oleifera and Ayurvedic formulations like Jatyadi Ghrita and Triphala for their effectiveness in treating diabetic foot remission.

Project Number

NA

References

  • Frequently Asked Questions: Diabetic Foot Ulcers, Michigan Medicine.; [cited 2022 August 8]. Available from: https://www.uofmhealth.org/conditions-treatments/podiatry-foot-care/frequently-asked-questions-diabetic-foot-ulcers [Website]
  • Diabetic foot ulcer.; [cited 2022 August 13]. Available from: https://toticell.com/diabetic-foot-ulcer [Website]
  • Diabetic Foot Ulcers.; [2022 August 13]. Available from: https://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causes-treatments [Website]
  • Kuo YS, Chien HF, Lu W. Plectranthus amboinicus and Centella asiatica Cream for the Treatment of Diabetic Foot Ulcers. Evid Based Complement Alternat Med. 2012;2012:1–9.
  • Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention, diagnosis and classification. Am Fam Physician. 1998;57(6):1325–32, 1337–8.
  • Shah P, Inturi R, Anne D, Jadhav D, Viswambharan V, Khadilkar R, et al. Wagner’s Classification as a Tool for Treating Diabetic Foot Ulcers: Our Observations at a Suburban Teaching Hospital. Cureus [Internet]. 2022 Jan 22 [cited 2023 May 20]; Available from: https://www.cureus.com/articles/82780-wagners-classification-as-a-tool-for-treating-diabetic-foot-ulcers-our-observations-at-a-suburban-teaching-hospital
  • Diabetic Foot Ulcers- Symptoms, Causes, and Risk Factors - Pristyn Care: [cited 2022 August 15]. Available from: https://www.pristyncare.com/blog/diabetic-foot-ulcers-symptoms-causes-risk-factors-pc0441/ [Website]
  • Rosyid FN. Etiology, pathophysiology, diagnosis and management of diabetics’ foot ulcer. Int J Res Med Sci. 2017;5(10):4206.
  • Neuropathic Ulcer.: [cited 2022 August 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559214/ [Website]
  • Aumiller WD, Dollahite HA. Pathogenesis and management of diabetic foot ulcers. JAAPA 2015;28(5):28–34.
  • Clayton W, Elasy TA. A Review of the Pathophysiology, Classification, and Treatment of Foot Ulcers in Diabetic Patients. Clin Diabetes. 2009;27(2):52–8.
  • Bharara M, Cobb JE, Claremont DJ. Thermography and Thermometry in the Assessment of Diabetic Neuropathic Foot: A Case for Furthering the Role of Thermal Techniques. Int J Low Extrem Wound. 2006;5(4):250–60.
  • Ankle-Brachial Index Use in Patients with Diabetes : Advances in Skin & Wound Care.: [cited 2022 August 14]. Available from https://journals.lww.com/aswcjournal/Citation/2004/04000/Ankle_Brachial_Index_Use_in_Patients_with_Diabetes.8.aspx [Website]
  • Lam K, van Asten SAV, Nguyen T, La Fontaine J, Lavery LA. Diagnostic Accuracy of Probe to Bone to Detect Osteomyelitis in the Diabetic Foot: A Systematic Review. Clin Infect Dis. 2016;63(7):944–8.
  • Plassmann P, Monitoring chronic wounds and determining treatment. Farrar. D. UK: Advanced Wound Repair Therapies, Woodhead Publishing, 2011, pp. 130–152.
  • Tornow M, Kaszubiak J, Kuhn R, Michaelis B, Schindler T. Hardware Approach for Real Time Machine Stereo Vision. Int J Syst Cybern Inform. 2005;4.
  • Pena G, Kuang B, Szpak Z, Cowled P, Dawson J, Fitridge R. Evaluation of a Novel Three-Dimensional Wound Measurement Device for Assessment of Diabetic Foot Ulcers. Adv Wound Caref. 2020;9(11):623–31.
  • Pappachan JM, Cassidy B, Fernandez CJ, Chandrabalan V, Yap MH. The role of artificial intelligence technology in the care of diabetic foot ulcers: the past, the present, and the future. World J Diabetes. 2022;13(12):1131–9.
  • Nather A, Cao S, Chen JLW, Low AY. Prevention of diabetic foot complications. Singapore Med J. 2018;59(6):291–4.
  • Najafi B, Reeves ND, Armstrong DG. Leveraging smart technologies to improve the management of diabetic foot ulcers and extend ulcer‐free days in remission. Diabetes Metab Res Rev. 2020: 36 Suppl 1, e3239.Zhang X na, Ma Z
  • Zjun, Wang Y, Sun B, Guo X, Pan C qing, et al. Angelica Dahurica ethanolic extract improves impaired wound healing by activating angiogenesis in diabetes. Caporali A, editor. PLoS ONE. 2017;12(5):e0177862.
  • Everett E, Mathioudakis N. Update on management of diabetic foot ulcers: Diabetic foot ulcers. Ann NY Acad Sci. 2018;1411(1):153–65.
  • Tchanque‐Fossuo CN, Ho D, Dahle SE, Koo E, Li C, Isseroff RR, et al. A systematic review of low‐level light therapy for treatment of diabetic foot ulcer. Wound Rep and Reg. 2016;24(2):418–26.
  • Karkada G, Maiya GA, Arany P, Rao M, Adiga S, Kamath SU. Effect of Photobiomodulation Therapy on Oxidative Stress Markers in Healing Dynamics of Diabetic Neuropathic Wounds in Wistar Rats. Cell Biochem Biophys. 2022;80(1):151–60.
  • Wound Care Dressing – Maxiocel.: [cited 2022 August 16]. Available from: https://axiobio.com/maxiocel/wound-care-dressing/ [Website]
  • Maxiocel – 100% Chitosan Wound Dressing on Diabetic Foot Infection (Amputation).: [cited 2022 August 14]. Available from: https://axiobio.com/uploads/pdf/maxiocel/diabetic-foot-infection-amputation-case-study-6-maxiocel.pdf [Website]
  • Maxiocel – 100% Chitosan Wound Dressing on Diabetic Foot Infection (Amputation).: 2022 August 14. Available from: https://axiobio.com/uploads/pdf/maxiocel/diabetic-foot-infection-amputation-case-study-6-maxiocel.pdf [Website]
  • Heuch L, Streak Gomersall J. Effectiveness of offloading methods in preventing primary diabetic foot ulcers in adults with diabetes: a systematic review. JBI Database Syst Rev Implement. 2016;14(7):236–65.
  • Oguntibeju OO. Medicinal plants and their effects on diabetic wound healing. Vet World. 2019;12(5):653–63.
  • Jia H, Yang B, Li Y, Liang C, Lu H, Lin D, et al. Chinese medicine ulcer oil promotes the healing of diabetic foot ulcers. J Int Med Res. 2018;46(7):2679–86.
  • Sun Y, Lenon GB, Yang AWH. Phellodendri Cortex: A Phytochemical, Pharmacological, and Pharmacokinetic Review. Evid Based Complement Alternat Med. 2019;2019:1–45.
  • Xiong Y, Huang H, Li Y, Jiang G, Du L. Effect of Yinhuangsan (YHS) on Diabetic Foot Ulcers (DFU): A Systematic Review and Meta-Analysis. J Diabetes. 2021;11(03):97–114.
  • Liu Y, Li Y, Du Y, Huang T, Zhu C. Multicenter Clinical Trials Analyzing Efficacy and Safety of Topical Cortex Phellodendri Compound Fluid in Treatment of Diabetic Foot Ulcers. Med Sci Monit [Internet]. 2020 Jun 19 [cited 2023 May 20];26. Available from: https://www.medscimonit.com/abstract/index/idArt/923424
  • Lee K, Shin MS, Ham I, Choi HY. Investigation of the mechanisms of Angelica dahurica root extract-induced vasorelaxation in isolated rat aortic rings. BMC Complement Altern Med. 2015;15(1):395.
  • Guo J, Hu Z, Yan F, Lei S, Li T, Li X, et al. Angelica dahurica promoted angiogenesis and accelerated wound healing in db/db mice via the HIF-1α/PDGF-β signaling pathway. Free Radic Biol Med. 2020;160:447–57.
  • Babu Natarajan S, Das SK, Chandran SP, Myo Oo A, Kanneppady SS, Entezarian M, et al. Moringa oleifera leaf extract loaded hydrogel for diabetic wound healing. Malaysian J Med Res. 2018;2(2):35–41.
  • Amali Muhammad A, Fakurazi S, Arulselvan P, See CP, Abas F. Evaluation of wound healing properties of bioactive aqueous fraction from Moringa oleifera Lam on experimentally induced diabetic animal model. Drug Des Devel Ther. 2016;1715.
  • Gupta R, Mathur M, Bajaj VK, Katariya P, Yadav S, Kamal R, et al. Evaluation of antidiabetic and antioxidant activity of Moringa oleifera in experimental diabetes: Antidiabetic activity of M. oleifera. J. Diabetes. 2012;4(2):164–71.
  • Kulkarni Y, Emmi S, Dongargaon T, Wali A. Wound healing effect of Vimlāpanakarma with Jātyādi tailam in diabetic foot. Ancient Sci Life. 2015;34(3):171.
  • Dhande P, Simpy R, Nargis I, Sanghavi D, Vijaya A. Burn wound healing potential of Jatyadi formulations in rats. Res J Pharm Biol Chem Sci. 2012;3:747–54.
  • Jose A, Adiga S, Ciraj A, Shettigar K, Velladath S, Ramachandra L. Management of grade IV diabetic foot ulcer by vrana ropana chikitsa: A case study. J Med Sci. 2021;0(0):0.
  • Lim JZM, Ng NSL, Thomas C. Prevention and treatment of diabetic foot ulcers. J R Soc Med. 2017;110(3):104–9.
  • Manning L, Hamilton EJ, Raby E, Norman PE, Davis W, Wood F, et al. Spray on skin for diabetic foot ulcers: an open label randomised controlled trial. J Foot Ankle Res. 2019;12(1):52.
  • Aerosol images.: [cited 22 August 2022]. Available from: https://www.pngwing.com/en/free-png-zeqnb [Website]
  • Pharmaceutical aerosol – uses and advantages.: [cited 2022 August 22]. Available from: http://pharmabiz.com/NewsDetails.aspx?aid=113171&sid=9 [Website]
There are 45 citations in total.

Details

Primary Language English
Subjects Pharmacology and Pharmaceutical Sciences
Journal Section Review Articles
Authors

Het Talati 0000-0003-1617-3160

Punitkumar Bhatt

Project Number NA
Publication Date June 1, 2023
Acceptance Date May 20, 2023
Published in Issue Year 2023 Volume: 43 Issue: 2

Cite

Vancouver Talati H, Bhatt P. A Comprehensive Review on Diagnosis and Management of Diabetic Foot Ulcers with Possible Ayurvedic and Herbal Remedies. HUJPHARM. 2023;43(2):185-94.