VOLUME 14 NUMBER 1 • JULY 2017
SA JOURNAL OF DIABETES & VASCULAR DISEASE
quality of life. Identifying a treatment modality to help resolve this
complication remains a difficult task in clinical practice. However a
number of clinical trials suggest LLLT as an alternative and promising
treatment modality that, when combined with other conventional
treatments, has shown potential in improving the healing rate of
chronic diabetic ulcerations. It is therefore essential to recognise
that with the use of LLLT in podiatry and other wound clinics, the
treatment or management of chronic diabetic lower-limb ulcerations
can be reduced to an average of 19 sessions to achieve a complete
compared to 40 sessions using conventional treatments
This could lead to reduced hospital admissions for people
with diabetic ulcers and lighten the substantial public health and
socio-economic burden to our country. Further investigations are
necessary to obtain conclusive evidence of low-level laser in treating
diabetic foot ulcers in South Africa.
This work is based on research supported by the University of
Johannesburg and the South African Research Chairs Initiative of
the Department of Science and Technology and National Research
Foundation of South Africa (Grant No 98337). The authors thank
the National Laser Centre for the supply and servicing of lasers.
Mbanya JCN, Motala AA, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan
International Diabetes Federation. Diabetes Atlas, 7th edn. Brussels: International
Diabetes Federation, 2015
Rheeder P. Type 2 diabetes: the emerging epidemic.
S Afr Family Prac
Edmonds ME. Metabolic disorders. In: Lorimer D, Frowen P, O’Donnell M, Burrow
Neal’s Disorders of the Foot
, 8th edn. Europe: Churchill Livingstone, 2010;
Minatel DG, Frade MAC, Franca SC, Enwemeka CS. Phototherapy promotes
healing of chronic diabetic leg ulcers that failed to respond to other therapies.
Laser Surg Med
Clarke A. Avoiding foot complications in diabetes.
Contin Med Ed
Brem H, Tomic-Canic M. Cellular and molecular basis of wound healing in
J Clin Invest
Cavanagh PR, Bus SA. Off-loading the diabetic foot for ulcer prevention and
J Vasc Surg
Bergin SM, Wraight PR, Burr JM. Australian diabetes foot network: management
of diabetes-related foot ulceration – a clinical update.
Med J Australia
10. Guo S, Di Pietro LA. Factors affecting wound healing.
J Dent Res
11. Jain AKC. A new classification of diabetic foot complications: a simple and
effective teaching tool.
J Diabetic Foot Complicat
12. Beckmann KH, Meyer-Hamme G, Schröder S. Low level laser therapy for the
treatment of diabetic foot ulcers: a critical survey.
Evidence-Based Comp Alt Med
; 2014: 1–9.
13. Chadwick P, Edmonds M, McCardle J, Armstrong D. International best practice
guidelines: wound management in diabetic foot ulcers.
14. Clarke EAM, Tsubane M. The role of a podiatrist in managing the diabetic foot
Wound Heal Sth Afr
15. Kim PJ, Attinger CE, Evans KK. Role of a podiatrist in diabetic limb salvage.
16. Houreld NN. Shedding light on a new treatment for diabetic wound healing: a
review of phototherapy.
2014; 2014: 1–13.
17. Petrova N, Edmonds M. Emerging drugs for diabetic foot ulcer.
18. Falanga V. Wound healing and its impairment in the diabetic foot.
19. Clayton W, Elasy TA. A review of pathophysiology, classification and treatment of
foot ulcers in diabetic patients.
20. Bus SA, Valk GD, van Deursen RW,
The effectiveness of footwear and
offloading interventions to prevent and heal foot ulcers and reduce plantar
pressure in diabetes: a systematic review.
Diabetes Metab Res Rev
21. Mueller MJ, Lott DJ, Hastings MK, Commean PK, Smith KE, Pilgram TK. Efficacy
and mechanism of orthotic devices to unload metatarsal heads in people with
diabetes and a history of plantar ulcers.
22. Tong JWK, Ng EYK. Preliminary investigation on the reduction of plantar loading
pressure with different insole materials (SRP – Slow Recovery Poron
, P – Poron
PPF – Poron
+ Plastazote, firm and PPS – Poron
+ Plastazote, soft).
23. Sambrook E, Delpierre T, Bowen G. Advancing the gold standard in offloading the
diabetic foot: product evaluation.
Wounds UK EWMA Special
24. Raspovic A, Landorf KB. A survey of offloading practices for diabetes-related
plantar neuropathic foot ulcers.
J Foot Ankle Res
25. Fife CE, Carter MJ, Walker D. Why is it so hard to do the right thing in wound
Wound Repair Regen
26. Fife CE, Carter MJ, Walker D,
Diabetic foot ulcer offloading: the gap
between evidence and practice. Data from the US Wound Registry.
27. Armstrong DG, Wu S, Lavery LA, Boulton AJM. Evaluation of removable and
irremovable cast walkers in the healing of diabetic foot wounds: a randomized
28. Faglia E, Curci V,
Effectiveness of removable walker cast versus non-
removable fiberglass off-bearing cast in the healing of diabetic plantar foot ulcer:
a randomized controlled trial.
29. Chadwick P, McCardle J, Cundell J, Towson M. Foot in Diabetes UK. The principle
of debridement: the diabetic foot. Developing Scope of Practice for Podiatrists in
the UK. 2014; 2014: 2–20.
30. Ahmad I, Akhtar S, Masoodi Z. Role of early radical debridement and skin cover
in diabetic foot ulceration.
J Wound Care
(9): 442–444, 446–447.
31. Williams D, Enoch S, Miller D, Harris K, Price P, Harding KG. Effect of sharp
debridement using curette on recalcitrant non-healing venous leg ulcers: A
concurrently controlled, prospective cohort study.
Wound Repair Regen
32. Wolcott RD, Kennedy JP, Dowd SE. Regular debridement is the main tool for
maintaining a healthy wound bed in most chronic.
J Wound Care
33. Cardinal M, Eisenbud DE, Armstrong DG,
Serial surgical debridement: a
retrospective study on clinical outcomes in chronic lower extremity wounds.
Wound Repair Regen
34. Wilcox JR, Carter MJ, Covington S. Frequency of debridement and time to heal: a
retrospective cohort study of 312744 wounds.
J Am Med Assoc Dermatol
35. Nteleki B, Houreld NN. The use of phototherapy in the treatment of diabetic
J Endocrin Metab Diabetes S Afr
36. Dinh TL, Veves A. Treatment of diabetic ulcers.
37. Dyson M. Low level laser therapy, 2014. [article] Available from: http://www.softlasers.com/low-level-laser-therapy-article.php.
38. Houreld NN, Abrahamse H. Low intensity laser irradiation stimulates wound
healing in diabetic wounded fibroblast cells (WS1).
Diabetes Technol Ther
39. Hamblin MR, Demidova TN. Mechanism of low level laser light therapy.
40. Mokmeli S, Daemi M, Shirazi ZA, Shirazi FA, Hajizadeh M. Evaluating the efficiency
of low level laser therapy (LLLT) in combination with intravenous laser therapy
(IVL) on diabetic foot ulcer, added to conventional therapy.
Lasers Med Sci
41. Enwemeka CS, Williams D, Hollosi S, Yens D. Blue light photo destroys methicillin-
resistant Staphylococcus aureus (MRSA) in vitro.
Photomed Laser Surg
42. Kajagar BM, Godhi AS, Pandit A, Khatri S. Efficacy of low level laser therapy
on wound healing in patients with chronic diabetic foot ulcers – a randomised
Indian J Surg
43. Kazemi-Khoo N. Successful treatment of diabetic foot ulcers with low-level laser
44. Lipovsky A, Nitzan Y, Lubart R. A possible mechanism for visible light-induced
Lasers Surg Med
45. Ankri R, Lubart R, Taitelbaum H. Estimation of the optimal wavelengths for laser
induced wound healing.
Lasers Surg Med
46. Cavanagh PR, Lipsky BA, Bradbury AW, Botek G. Treatment for diabetic foot