Diabetic Foot Ulcer Prevention, Treatment and Causes

1. Introduction of Diabetes Mellitus:-

Diabetes is a group of metabolic diseases characterized by hyperglycemia resulting from defects

in insulin secretion, insulin action, or both. The chronic hyperglycemia of diabetes is associated
with long-term damage, dysfunction, and failure of different organs, especially the eyes, kidneys,
nerves, heart, and blood vessels. Several pathogenic processes are involved in the development
of diabetes.[Genuth S, 2003] These range from autoimmune destruction of the b-cells of the
pancreas with consequent insulin deficiency to abnormalities that result in resistance to insulin
action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism in diabetes is
deficient action of insulin on target tissues. In 2000, according to the World Health Organization,
at least 171 million people worldwide suffered from diabetes and due to such increasing rates, it
is estimated that by 2030, it will double.Major multifaceted complications are associated with
diabetes.These include retinopathy, neuropathy, atherosclerosis, nephropathy and foot ulcers.
These complications are a result of defect in vascular system causing inappropriate circulation.
[Bakshu LM, 2001]

Signs & symptoms

 Increase thirst
 Frequent urination
 Hunger
 Fatigue
 Blurred vision [Patel D.K., 2012]

1.1) Introduction of Diabetic Foot Ulcer:-

Foot ulcers are defined as lesions involving a skin break with loss of epithelium, they can extend
into the dermis and deeper layers sometimes involving bone and muscle.Diabetic foot ulcer is an
open sore or wound that occurs in approximately 15 percent of patients with diabetes, and is
commonly located on the bottom of the foot. [ Joseph WS, 2003]

It is usually the result of poor glycemic control, underlying neuropathy, peripheral vascular
disease, or poor foot care.These ulcers are usually in the areas of the foot which encounters

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repetitive trauma and pressure sensations.[Reed JF,2004] Staphylococcus is the most common
infective organism.

The main reasons people with diabetes develop foot ulcers are:[J.I. Jones, 2019]

 Trauma or injury to the foot

 Poorly fitting shoes
 Poor blood flow to the foot
 Increased pressure to the foot
 Nerve damage which means you are unable to feel your feet properly

[Dennis F.Bandyk, 2019]

Fig:1 Diabetes Foot Ulcer

1.2) Classification:-

Following are the most importantly used classification systems:-[S.Noor, 2015]

a) Wagner-Meggit Classification System

b) Brodsky Depth-Ischemic Classification

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A.) The Wagner Diabetic Foot Ulcer Grade Classification System, for example, has six
grades:[Oyibo S.O, 2001]

Grade 0: Your skin is intact (undamaged).

Grade 1: The ulcer is “superficial,” which means that the skin is broken but the wound is shallow
(in the upper layers of the skin).

Grade 2: The ulcer is a “deep” wound.

Grade 3: Part of the bone in your foot is visible.

Grade 4: The forefront of your foot (the section closest to your toes) has gangrene (necrosis).

Grade 5: The entire foot has gangrene.

[Oyibo SO, 2001]

Fig:-2 Grade of DFU

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B.) Depth Ischemic Classification System:-[Armstrong D.G, 1998]

Table-1: Depth Ischemic Classification System

Depth Ischemia
Grade Definition Grade Definition
0 At risk, foot with previous ulcer A No ischemia
that may cause new ulcer
1 Superficial non-infected ulcer B Ischemia no gangrene
2 Deep ulcer with tendon or joint C Partial forefoot gangrene
exposed(+/- infection)
3 Extensive ulcer with bone D Total foot gangrene
exposed or deep abscess

Signs & Symptoms:-[Alavi. A, 2014]

 Swelling
 Drainage or blood in shoes or socks
 Large calluses or cracked heals
 Blisters
 Redness
 Sores
 Splinders
 Scraps
 Pus
 Pain
 Hardening of the skin

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A B

C D

E F

A. Sweeling in DFU; B.Blisters in DFU; C.Redness in DFU; D. Sores in DFU; E. Pus in DFU; F.Scraps in DFU

Fig:- 3. Signs and Symptoms

1.3) Epidemiology:-

 Both Type 1 and Type 2 diabetics are prone to develop foot ulcers.[Rather H.M,
2007]The lifetime risk to a person with diabetes for developing a foot ulcer could be as
high as 25%. The rate of lower limb amputations is 15 times higher in diabetic patients
compared with non-diabetics . Foot problems account for more hospital admissions than

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any other long-term complications of diabetes and also result in increasing morbidity and
mortality.[Boyko E.J,1996]
 The annual incidence of diabetic foot ulcer worldwide is between 9.1 to 26.1
million.Around 15 to 25% of patients with diabetes mellitus will develop a diabetic foot
ulcer during their lifetime. As the number of newly diagnosed diabetics are increasing
yearly, the incidence of diabetic foot ulcer is also bound to increase. [P. Zhang, 2017]
 Diabetic foot ulcers can occur at any age but are most prevalent in patients with diabetes
mellitus ages 45 and over. Latinos, African Americans, and Native Americans have the
highest incidence of foot ulcers in the US.

1.4) Pathophysiology:-

The development of a diabetic ulcer is usually in 3 stages. The initial stage is the development of
a callus. The callus results from neuropathy. The motor neuropathy causes physical deformity of
the foot, and sensory neuropathy causes sensory loss which leads to ongoing trauma. Drying of
the skin because of autonomic neuropathy is also another contributing factor. Finally, frequent
trauma of the callus results in subcutaneous hemorrhage and eventually, it erodes and becomes
an ulcer.[Alavi A, 2014]

Patients with diabetes mellitus also develop severe atherosclerosis of the small blood vessels in
the legs and feet, leading to vascular compromise, which is another cause for diabetic foot
infections. Because blood is not able to reach the wound, healing is delayed, eventually leading
to necrosis and gangrene.

1.5) Causes & Risk Factors of Diabetes Foot Ulcer:-

Ulcers in people with diabetes are most commonly caused by:

 poor circulation

 high blood sugar (hyperglycemia)

 nerve damage

 irritated or wounded feet

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Poor blood circulation is a form of vascular disease in which blood doesn’t flow to your feet
efficiently. Poor circulation can also make it more difficult for ulcers to heal.[Bus SA, 2016]

High glucose levels can slow the healing process of an infected foot ulcer, so blood sugar
management is critical. People with type 2 diabetes and other ailments often have a harder time
fighting off infections from ulcers.

Nerve damage is a long-term effect and can lead to a loss of feeling in your feet. Damaged
nerves can feel tingly and painful. Nerve damage reduces sensitivity to foot pain and results in
painless wounds that can cause ulcers.For example, a person may acquire an injury such as a
blister but not notice it due to not feeling pain in their feet. This may result in the wound not
being treated, causing it to worsen and develop into an ulcer.

Ulcers can be identified by drainage from the affected area and sometimes a noticeable lump that
isn’t always painful. [S. Noor, 2015]

Other risk factors for diabetic ulcers may include:[Dubsky M. 2013]

 older age
 longer duration of diabetes
 smoking
 obesity
 hypertension
 poor circulation in extremities, such as the feet
 inflammation
 changes in white blood cell counts
 alcohol consumption
 tobacco use

1.6) Diagnosis:-Diabetes foot ulcer can be diagnosed by various techniques:-

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 MRI Scan:- MRI scans use a magnetic field and radio waves to create computerized,
three-dimensional images of soft tissues inside the body. Your doctor may recommend
this test if he or she needs more information about the extent of damage caused by an
ulcer.[Lanzer.P, 2017] MRI images can also reveal inflammation, which may be a sign of
infection.[Whatson J.C,2015] MRI can provide valuable diagnostic information by
allowing the early identification of soft tissue edema, bone marrow edema,
microfractures, hidden fracture lines or abnormal bone turnover before it can be seen on
radiographs.
 X-Ray:- Performed for the detection of the spread of the lesion and soft tissue
involvement.
 Blood Test:- If there are signs of infection, such as redness, swelling, and warmth in the
affected foot, your doctor may recommend a blood test to screen for it. This takes place
in a doctor’s office, and the results are usually available within a week.[Lipsky B.A,
2004]
 Bone Scintigraphy:- Bone scintigraphy is a common nuclear medicine procedure and can
be useful for the evaluation of diabetic osteoarthropathy by revealing an increased uptake
along the affected bone and joints . A Technetium-99m labeled methylene diphosphonate
(Tc-MDP) is used for imaging, which is commonly performed in three phases. Imaging
directly after injection demonstrates the perfusion of the foot . The second phase
demonstrates leakage of imaging agents to surrounding soft-tissues/ muscles. After this
follows the delayed phase, where the tracer uptake mirrors the rate of bone remodulation.
Additionally, a fourth phase can be added after 24 hours by showing a static image that
can enhance specificity. A disadvantage of scintigraphy is the poor spatial resolution and
the lack of anatomical landmarks. The more modern hybrid systems combining a gamma
camera with Computed Tomography (SPECT/CT) overcome this last limitation.

Other differential diagnosis may include:-[Berendt AR, 2008]

 Blunt bone trauma

 Bone tumour
 Gas gangrene

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 Lyme arthritis
 Osteomyelitis
 Sarcoid arthritis
 Sickle cell crisis
 Squamous cell carcinoma
 Superficial thromophlebitis
 Synergistic gangrene

2. Prevention of DFU:-

The primary goal in the treatment of foot ulcers is to obtain healing as soon as possible. The
faster the healing of the wound, the less chance for an infection.[Yang C, 2014]There are several
key factors in the appropriate treatment of a diabetic foot ulcer:

 Prevention of infection
 Taking the pressure off the area, called “off-loading”
 Removing dead skin and tissue, called “debridement”
 Applying medication or dressings to the ulcer
 Managing blood glucose and other health problems [Lavery L.A,2007]

Not all ulcers are infected; however, if your podiatric physician diagnoses an infection, a
treatment program of antibiotics, wound care, and possibly hospitalization will be necessary.

1.) Prevention Infection:- There are several important factors to keep an ulcer from
becoming infected: [A. Alavi, 2014]
 Keep blood glucose levels under tight control
 Keep the ulcer clean and bandaged
 Cleanse the wound daily, using a wound dressing or bandage
 Do not walk barefoot
2.) Off-Loading:-

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 For optimum healing, ulcers, especially those on the bottom of the foot, must be “off-
loaded.” Patients may be asked to wear special footgear, or a brace, specialized castings,
or use a wheelchair or crutches. These devices will reduce the pressure and irritation to
the ulcer area and help to speed the healing process.[Bus SA, 2008]
 The science of wound care has advanced significantly over the past ten years. The old
thought of “let the air get at it” is now known to be harmful to healing. We know that
wounds and ulcers heal faster, with a lower risk of infection, if they are kept covered and
moist. The use of full-strength betadine, peroxide, whirlpools and soaking are not
recommended, as this could lead to further complications.
3.) Applying Medication and Dressing:-
 Appropriate wound management includes the use of dressings and topically-applied
medications.[Armstrong DG, 2005] These range from normal saline to advanced
products, such as growth factors, ulcer dressings, and skin substitutes that have been
shown to be highly effective in healing foot ulcers.[Dumville J.C, 2013]
 For a wound to heal there must be adequate circulation to the ulcerated area. Your
podiatrist may order evaluation test such as noninvasive studies and or consult a vascular
surgeon.[Deshpande O, 2013]
4.) Managing Blood Glucose:- Tightly controlling blood glucose is of the utmost importance
during the treatment of a diabetic foot ulcer. Working closely with a medical doctor or
endocrinologist to accomplish this will enhance healing and reduce the risk of
complications.
5.) Surgical Options: A majority of noninfected foot ulcers are treated without surgery;
however, when this fails, surgical management may be appropriate. Examples of surgical
care to remove pressure on the affected area include shaving or excision of bone(s) and
the correction of various deformities, such as hammertoes, bunions, or bony
“bumps.”[Candel Gonzalez FJ, 2003]
6.) Healing Factors:- Healing time depends on a variety of factors, such as wound size and
location, pressure on the wound from walking or standing, swelling, circulation, blood
glucose levels, wound care, and what is being applied to the wound. Healing may occur
within weeks or require several months.[Wall IB, 2002]

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7.) Patient Education:- Education patients on proper foot care and periodic examinations can
help prevent foot problems and ulcerations. [Dorresteijn JA, 2014]
 Take care of your diabetes and your health
 Check your feet every day
 Wash your feet every day
 Keep your skin soft and smooth
 Protect your feet from extreme temperatures[Corbett C.F, 2003]

3.Treatment:-

3.1.) Allopathic Formulation:-

Table:2. Allopathic Formulation of DFU

Sr.No. Name of the Mechanism of Action Dose Side effect References

formulation

OINTMENTS

1. Cadexomer Cadexomer can kill Apply 2 Rashes, Apelqvist.J

iodine bacteria, and absorbs times a day itching;redness , 1996
pus and clean wound so , swollen,
it can heal faster blistered or
pelling skin

2. Povidone Iodine rapidly 1or 2 time Blistering or Khandelwa

iodine panetrates into crusting, l S, 2013,
microorganism and severe Ramos C,

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oxidizes key proteins, daily irritation, 2007

nucleotides and fattly swelling, pain,
acid, eventually leading warmth,
to cell death. redness

3. Bacitracin c Preventing the 2 or 3 dose in Itching, rash, Tian X,

hydrolysis of lipid every day hives, 2013
dolichol pyrophosphate difficulty
which inhibits the cell breathing or
wall synthesis swallowing

4. Fusidic Acid Fusidic Acid inhibits Apply 3 or 4 Red, itchy or Bus

protein synthesis by times a day stinging eyes, SA,2016
binding EF-G-GDP, brown or
which results in the black skin
inhibitions of both
peptide translocation &
ribozomes disassambly

5. Mupirocin It inhibits bacterial Apply twice Itchiness, Landsman

and protein synthesis by a day redness, A, 2011
mupirocin reversible inhibition of headache,
calcium ILe tRNA synthase nausea

6. Cetrimide Cetrimide dissociate to Apply 2 Nausea, Lipsky

a biologically-active times a day vomiting , skin B.A, 2004
cation and inactive irritation,

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anion. Cetrimide is redness of the

inactive towards skin, rarely
bacterial spores, it is burn
effective against some
viruses and has variable
anti-fungal activity

SOLUTIONS

7. Acetic acid Most pathogenic 3 to 5 drops Mild stinging Bowling F,

bacteria require pH in every four or burning 2015
value>6 & their to six hours
growth is inhibited by
lower Ph

8. Hexachloroph Hexachlorophene Apply 5 ml Skin rashes, Tesfaye

ene inhibit the membrane and rub for 3 rednes, S,2013
bound part of the minutes cracked, dry
electron transport or scaly skin
chain, respiratory D- swelling
lactate dehydrogenase.

CREAMS

9. Chlorhexidine Distuption of cell Apply every Skin irritation, Callaghan

membrane because of 24 hours for

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gluconate its cationic nature six weeks dryness BC, 2012

CHX attaches to the
negatively charged
sites in the bacterial
cell wall and interferes
with osmosis thereby
disrupting the cell

10. Mafenide It reduce the bacterial Apply 3 Pain, redness, Schaper

acetate population in the times a day itchy skin, NC,2017
avacular burn tissue burning
and promotes sensation
spontaneous healing of
deep ones

11. Retapamulin It inhibits bacterial Apply 2 Skin irritation, Marchand

protein synthesis by times a day redness, C.,2012
binding to a unique itching
site on the ribosomal
50S subunits

12. Silver It inhibits protein Apply 2 Burmimg, Joacobs

Sulphadiazine synthesis by binding times a day itching, A.M, 2008
to 30S ribosomal irritation,
subunit. It prevent redness
AA-Trna to the
acceptor site on the
mRNA-ribosome

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complex

13. Nitrofurazone Inactivation of Apply thrice Rash, itching, Parry

ribosomal proteins and a day swelling, KK,1996
inhibition of proteins, headache
DNA, RNA and cell
wall synthesis,
blocking the aerobic
metabolism of
bacterial cells

TABLETS

14. Penicillin Penicillin kills bacteria 500mg twice Diarrhea, Searle

through binding of the a day headache, A,2008
Beta-lactum ring to stomach upset,
DD-transpeptidase, nausea,
inhibiting its cross vomiting
linking activity and
preventing new cell
wall formation

15. Amoxicillin Inhibiting the 250mg to Diarrhea, Sumpio

biosynthesis and repair 500mg twice headache, BE,2000
of the bacterial a day stomach upset,
nucleopeptide wall skin rash,
abnormal taste

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sense

16. Neomycin Neomycin works by 30 mg 3 Vomiting, Bus

sulfate binding to the times a day nausea, SA,2008
bacterial 30S diarrhea
ribosomal subunit,
thus inhibiting protein
synthesis

18. Metronidazol Metronidazole acts by IV 500 mg Headache, loss Tom W.L,

e inhibiting nucleic acid IV every 8 of appetite, 2005
synthesis by disrupting hours vomiting,
the DNA of microbial diarrhea,
cells Orally 250 heartburn
to500 mg 3
times a day

3.2.) Ayurvedic Formulation:-

Table:3. Ayurvedic Formulation of DFU

Sr. Herbal Manufacturing Ingredients Dose Dose References

no. formulation company Type

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1. Vasant Atrey Rajat bhasma, Tablet Once in a Sridharan

Kusumakar Pharamaceutical morning K, 2011
Swarnabhasma,V
Ras private limited, before
ang bhasma,
Gujarat
Abhrak bhasma,
Lauh bhasma

2. Haritaki Nagarjun Chitraka, amla, Powder ¼-1/2 Patel D.K,

pharmaceutical ela, patra, guda, 2014
teaspoon
guduchi,trikatu,ya
(P.)Ltd. of haritaki
vakshara
powder
with one
cup of
warm
water
twice a
day

3. Chandrapra Shree Amla, Camphor, Tablet 2 tablets Mishra R,

bha Vati Dhootapapeshwa Nagaramustaka, in a day 2011
r Ltd. ginger, Vacha,
Bay leaf, chavya,
Gaja pippali, Atis

4. Katupila KP Impex, Sri Katupila churna, Paste Apply 3 Shastri A,

kalka/Paan Lanka til taila, katupila times a 2001
duraphalika kwatha day
Singhal
GD,2007

5. Jatyadi Oil Shree baidyanath Jatiputra, neem, Herbal oil Twice a Akkol E.K,
ayurved bhawan patol, karanja,

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pvt. Ltd.,Jhansi haldi, beeswa, day 2009

kuth, sesame
oil,tuthya,neel
kamal

6. Chopchiny Shree baidyanath Sugar, triphala Powder 2 or 3 gm Mukherjee

adi churna ayurved bhawan churna, ginger, with warm P.K,2009
pvt. Ltd., Jhansi kokilaksha, milk or
vidanga, water , 1
chopchini, or 2 times
blackpepper, a day,
pippalimoola, after or
twak, clove before
meals

7. Mahamanji Shree Daruharidra, Syrup Twice a Singhal

shthadyaris Baidyanath giloy, manjishtha, day GD,2007
hta Ayurved shatavari,
Bhawan Pvt. Ltd jaggery, vidanga,
triphala

8. Sushrut’s Rajendra Nagar Guduchi, gokhru, Ointment once a day Acharya

Komal Chowk, Bilaspur resin, arka, YT,2001
nimbu, vasa,
nirgundi, karanja,
genda, bee wax,
alsi oil

9. Natural QR Sitaram Pongamia Ointment Twice a Peterson

Ayurveda pvt. pinnata, Lawsonia day CT, 2017
Ltd. Thrissur, alba, datura alba,

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Kerala Cocos nucifera

10. D- Sore Aerosol Datura metel, Spray Once or Sharma V,

specialities, curcumin, neem, twice a 2017
Delhi acorus calamus day

11. Synerzyme Synerheal Papain, urea Gel Daily Shah J,

Pharmaceuticals, night 2007
Chennai, Tamil
Nadu

12. Diabestat Shaleen Jamun, gurmar Capsule 2 or 3 Bowling F,

Pharmaceuticals, patti, bilaw, times a 2015
Panchkula neem, karela, day
methi,shilajeet
suddha

13. Grahams Manufactured in Punica granatum Ointment Once a [Nehete

natural Australia fruit extract, urea, day M.N, 2016]
cream cetyl alcohol,
castor oil,
coconut
oil,carnauba wax

14. Terrasil Aidance Beeswax, Ointment Twice a Corbett CF,

scientific, US bentonite, cotton day 2003
seed oil, jojoba morning
seed oil, or evening
magnesium oxide,
peppermint, sage
oil, tea tree oil,

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zinc oxide

15. Ultra Bioayurveda Haldi, kapur oil, Ointment Thrice a Joseph WS,
Healing vilayati sounf oil, day 2003
Foot kali mirch oil,
Cream nilgiri oil, pudina
oil, lavender oil

16. DiaFC Apex Laboratory Aloe barbedensis, Lotion Twice a Peters EJ,
pvt.Ltd, coconut oil, day 2001
Tamilnadu glycerin, castor
oil, seasame oil,
cocoa butter,
cassia alata,
moringa oleifera
etract, grape seed
oil, olive oil,
vitaminE acetate

17. Swarnasilla Maharshi Badri Shilajit, kesar, Capsule Twice a Haque

pharmaceutical bhasma, gokharu day M.M,2003
pvt. Ltd. , Jaipur, chota,
Rajasthan ashwagandha,
methi, kali
mirch,giloy

18. Madhusam Madhuram micro Neem, karela, Powder One spoon Mishra R,
Powder rajkot jamun, methi, of powder 2011
pharmaceutical giloy,vijaysar, twice a
pvt Ltd, Gujarat gurmar, amalaki, day with
paneerdodi warm

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water

19. Siddhayu Siddhayu Gudmar, jamun, Cream Apply 3 or Pradhan. L,

Diabo Baidyanath saptarangi, 4 times on 2013
Yogue Nagpur cinnamon, neem, healing
chirayta, karela, area
methi dana

20. Diaetic feet Manufactured in Seed oil, Cream Twice a Mishra

South Africa soyabean,glyercyl day R,2011
stearate, ginger,
flower extract or
root extract

21. Tila Taila Dhanvantari guj. Gingelly oil, Oil Twice a Sharma
Herb, Anand turmeric, lodhra, day R.K. 2003
Gujarat nalika, haritalki,
vata ankura

3.3.) Homeopathic Formulation:-

Table:4. Homeopathic Formulation of DFU

Sr.No. Homeopathic Uses References

Remedie
1. Secale Cor 30 An ecxellent remedy for diabetic gangrene. Harrisson T.R,
Dry gangrene of toe. Dusky blue tinge.

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Skin feels cold to touch yet covering not 2012

telerated.
2. Aesenicum Diabetic gangrene. Burning and soreness, Boger C.M., 2003
Album-30 relieved by warmth. Fetid smell from the
wound.Restlessness
3. Apis Mellifica 30 Spreading cellulitis with burning stinging Boericke W, 2002
pain. Sensitive. Blebs are seen.
4. Antimonium Callosities are seen. Dry gangrene. Boericke W, 2001
Crudum
5. Carbo Vegetabis Carbuncles and boils becomes gangrenous. Shah J, 2005
30 Wet, purple and icy gold gangrene. Moist
gangrene.
6. Hepar Sulph 30 Blebs are seen. Very sensitive touch James.T, 1996
7. Lachesis 200 Bluish purple surroundings around Patel R.,1998
gangrene
08. Rhus Tox 30 Spreading cellulitis Rutten L., 2015
9. Sulphuric Acid Blue and purple surroundings of the Patel RP,1996
gangrene. Bleeding under the skin
10. Tarentula Cub 30 Painful and inflamed abscess with a Ali MS,2009
tendency to gangrene
11. Echinacea Q Emitting a foul smell ftom gangrene. 5 Murthy K,
drops in a little of water every 2 hours. 2017
Externally wash with a Echinacea lotion. It
acts as a cleaning and antiseptic agent.
12. S. Cumini S. Cumini. Has anti- inflammatory and Ponnam HB,2020
antioxidant properties and therefore
subsides the swelling and inflammation of
the diabetic foot wounds. S. Cumini also
purifies the blood and significantly
improves the condition of foot ulcer.
13. Calendula Calendula is a homeopathic medicine with Nayak C, 2011

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numweous benefits in the case of diabetic

foot ulcer. For treating DFU, calendula
works best when you use it topically.
Calendula gels or spray directly for the
DFU.
14. Conium Conium works on the nerves in the body. It Lopes L, 2011
treats the numbness and loss of sensation
caused due to prolonged diabetes.
15. Aconitum Aconitum Napellus is widely prescribed Jansen RB, 2019
Napellus for the treatment of acute foot ulcers. It
reduces the redness, soreness & swelling of
the foot ulcer. It also subsides the
numbness, burning and tingling sensation
of the foot wound and promotes wound
healing.
16. Thiosinaminum Specific for callosities. Dry gangrene. Health Quality
30 Ontario,2017

4. Market Survey Of Herbal Formulation of Diabetic Foot Ulcer:-

Sr.No. Name of Formulation Manufacturing company Price

1. Katupila kalka/ Grow up Pharmaceuticals, Faridabad Rs. 297
Paanduraphalika
2. Chopchinyadi churna Harisons Pharmaceutical work, Narwana, Rs.120
Jind
Grow up Pharmaceuticals, Faridabad Rs. 250
3. Vasant Kusumakar Vibdrugs Biosciences, Panchkula Rs. 750
Ras
4. Jatyadi Oil Jiva Ayurvedic Pharmacy Limites, Palla, Rs. 190
Faridabad
5. Haritaki powder Nutrihills Nutritional Foods, Gurgaon Rs. 500

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6. Chandraprabha VHCA Herbals, Karnal Rs. 375

Review based on their uses:-

In our market survey on Herbal formulation of Diabetic Foot ulcer, we survey on various chemist
shops in Rohtak, Panipat, Rewari & Sonipat to find the effectiveness of various herbal
formulation. In this, survey we find different formulations which are more effective for treatment
of Diabetic Foot Ulcer. These formulation may include Chopchinyadi Churna, Jatyadi Oil,
Haritaki, Chandraprabha, Katupila Kalka & Vasant Kusumakar Ras. We find that
ChopchinyadiChurna is mostly used and more effective for treatment of DFU.

40
35
30
25
20
15
10
5 Used Formulation
0
na a r s il
r ah de kla Ra O
hu ap
r
o w Ka ar adi
iC r
ki
P ila ak ty
ad nd up m Ja
ny a ir ta t su
i Ch Ha Ka u
pc
h tK
o san
Ch Va

Graph-1: Review based on their uses

Review Based on cost effective values:-In our market survey on Herbal formulation of Diabetic
Foot ulcer, we survey on various chemist shops in Rohtak, Panipat, Rewari & Sonipat to find the
cost of various herbal formulation. In this, survey we find different formulations which are more
effective & different price for treatment of Diabetic Foot Ulcer. These formulation may include
Chopchinyadi Churna, Jatyadi Oil, Haritaki, Chandraprabha, Katupila Kalka & Vasant

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Diabetic Foot Ulcer Prevention, Treatment and Causes

Kusumakar Ras. We find that Chopchinyadi Churna is mostly used and cost effective for
treatment of DFU.

800
700
600
500
400
300
200
100 Price
0
a a s il ki a
K alk urn
r Ra di
O
r ita abh
Ch r
pi
l a
ak
a ty
a Ha ra
p
tu adi m Ja d
Ka i ny us
u an
ch K Ch
o p
ant
Ch Va
s

Graph-2: Review based on Prices

5. Online Survey on Diabetic Foot Ulcer:-

4A 4B

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Diabetic Foot Ulcer Prevention, Treatment and Causes

4C
4D
Fig 4: Virtual response on DFU treatment via google form

In Fig 4, we showed google response on the treatment of DFU. We conduct a online survey in
google form in which we get 46 responses. In fig 4A we find that most of the person lies in the
age of 40-60 who suffered from DFU. In fig 4B we find that how much peoples are suffered
from DFU. In fig 4C we try to tell that mostly person are suffered from Diabetes more than 4
years. According to this survey, in fig 4D we find that mostly person preferred ayurvedic
treatment for curing DFU.

5A 5B

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Diabetic Foot Ulcer Prevention, Treatment and Causes

5C 5D

Fig 5: Virtual response on DFU treatment via google form

In Fig 5, we showed google response on the treatment of DFU. We conduct online survey in
google form. According to this survey, in fig 5A we find that in the herbal formulation mostly
person used Chopchinyadi churna and it is more effective than others. In fig 5B Herbal
formulation are more effective than allopathic and homeopathic formulations. In fig 5C we try to
tell this herbal drugs have very less side effects. So it is mostly used. Ayurvedic medication

usually preferred after leaving allopathic treatment are shown in fig 5D.

6. Conclusion:-

In recent years, great progress has been gained in understanding the pathogenesis and treatment
of diabetic foot problems. DFU biomarkers, as the representative characteristic properties of the
pathogenesis of diabetic wounds, can be helpful for further understanding of DFU, improving
early clinical diagnosis, disease prevention, disease progression prediction and even treatment
evaluation of DFU. Biochemical and molecular targets revealed by modern biotechnology
approaches can be used as novel potential biomarkers for DFU, which may be applied in the
diagnosis of DFU of the early stage after further researches from bench to bedsides, leading to
better treatment and thus preventing the trauma of amputation. Herbal formu;ation are more

effective than other to treat DFU. Optimal treatment of diabetic foot infections requires
pathogen specific antibiotic therapy and proper identification is indispensable.

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Diabetic Foot Ulcer Prevention, Treatment and Causes

7. Future Prospective on Treatment of DFU:-

Due to the increasing incidence of both DM and DFU globally, as well as predicted increases in
market growth to meet patient demand more advanced treatments for DFU wound healing will
be required in order to cope with clinical demand.

Future therapies currently under investigation for the treatment of diabetic foot ulcers include
platelet-rich plasma, stem cell therapy, extracorporeal shock-wave therapy, laser therapy and
topical lactoferrin.

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Diabetic Foot Ulcer Prevention, Treatment and Causes

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