Rationale and technique for subulcer ultrasonic treatment of hard-to-heal diabetic foot ulcers

Diabetic foot ulcers (DFUs) are common complications of suboptimally controlled diabetes, characterised by non-healing, high morbidity, infection, recurrence (40-50%) and mortality. Ultrasonic debridement technology has been used for >30 years to treat cataracts safely and effectively, and animal studies have suggested that ultrasound debridement stimulates collagen turnover. This technology was applied in developing a system for soft tissue removal in tendons and elsewhere, with intended use in the elbow, knee, ankle, foot and shoulder. It was then modified for the treatment of DFUs. In this study, the rationale behind using this technology is discussed, the procedural technique is described, and photographic examples of treatment outcomes presented.