Skip to content
2000
Volume 16, Issue 2
  • ISSN: 2210-3155
  • E-ISSN: 2210-3163

Abstract

Background and Aim

Diabetic foot ulcers (DFUs) constitute one of the most debilitating complications of diabetes mellitus (DM). The use of topical herbal products as adjuvant agents in wound dressing is one of the most widely used practices worldwide. The present review aimed to provide a detailed and comprehensive systematic review focusing on randomized clinical studies and critically analyze not only the clinical outcomes but also the methodological approaches used by these studies.

Methods

The present systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. For the extraction of relevant studies, three databases were searched: PubMed, Web of Science Core Collection, and Scopus by two independent researchers.

Results

A search of the three databases resulted in the identification of 5528 records which were reduced to 3224 after removal of duplicates. The application of inclusion and exclusion criteria left 35 full-text articles assessed for eligibility. Finally, 13 articles were excluded and only 22 articles were advanced to the final analysis. Most studies reported details of local ulcer management only while others reported the additional systemic/surgical measures used for management. The present review identified 18 botanical agents/preparations used alone or in combination with other agents as adjuvant agents in treatment of DFUs. In most situations, these agents proved to be effective.

Conclusion

The present review reported the methodological approaches and clinical outcomes of botanical extracts used topically for the treatment of diabetic foot ulcers in randomized controlled studies. These agents proved to be generally effective. However, many gaps existed in the study designs which may limit the evidence-based value of these studies.

Loading

Article metrics loading...

/content/journals/npj/10.2174/0122103155331492241025083322
2024-11-04
2025-12-21
Loading full text...

Full text loading...

References

  1. CrausS. MulaA. CoppiniD.V. The foot in diabetes – A reminder of an ever-present risk.Clin. Med. (Lond.)202323322823310.7861/clinmed2022‑048937197806
    [Google Scholar]
  2. LazzariniP.A. RaspovicK.M. MeloniM. van NettenJ.J. A new declaration for feet’s sake: Halving the global diabetic foot disease burden from 2% to 1% with next generation care.Diabetes Metab. Res. Rev.2023403e374710.1002/dmrr.374737997627
    [Google Scholar]
  3. DengH. LiB. ShenQ. ZhangC. KuangL. ChenR. WangS. MaZ. LiG. Mechanisms of diabetic foot ulceration: A review.J. Diabetes202315429931210.1111/1753‑0407.1337236891783
    [Google Scholar]
  4. ArmstrongD.G. TanT.W. BoultonA.J.M. BusS.A. Diabetic foot ulcers: A review.JAMA20233301627510.1001/jama.2023.1057837395769
    [Google Scholar]
  5. JiangP. LiQ. LuoY. LuoF. CheQ. LuZ. YangS. YangY. ChenX. CaiY. Current status and progress in research on dressing management for diabetic foot ulcer.Front. Endocrinol. (Lausanne)202314122170510.3389/fendo.2023.122170537664860
    [Google Scholar]
  6. HermanA. HermanA.P. Herbal products and their active constituents for diabetic wound healing - Preclinical and clinical studies.A systematic reviewPharmaceutics202315128110.3390/pharmaceutics1501028136678910
    [Google Scholar]
  7. ThomasA. NikamA. GiramP. NagoreD. ChitlangeS. Herbal-based dressings in wound management.Curr. Diabetes Rev.2023194e01042220293710.2174/157339981866622040110525635366781
    [Google Scholar]
  8. LiuY. LiY. DuY. HuangT. ZhuC. Multicenter clinical trials analyzing efficacy and safety of topical cortex phellodendri compound fluid in treatment of diabetic foot ulcers.Med. Sci. Monit.202026e92342410.12659/MSM.92342432817595
    [Google Scholar]
  9. KardoustM. SalehiH. TaghipourZ. SayadiA. The effect of kiwifruit therapeutics in the treatment of diabetic foot ulcer.Int. J. Low. Extrem. Wounds202120210411010.1177/153473461985170033527863
    [Google Scholar]
  10. JayalakshmiM.S. ThenmozhiP. VijayaraghavanR. Plant leaves extract irrigation on wound healing in diabetic foot ulcers.Evid. Based Complement. Alternat. Med.202120211910.1155/2021/992472534055026
    [Google Scholar]
  11. Fallah HuseiniH. YaghoobiM. FallahiF. Topical administration of teucrium polium on diabetic foot ulcers accelerates healing: A placebo-controlled randomized clinical study.Int. J. Low. Extrem. Wounds202123223824610.1177/1534734621104837134719966
    [Google Scholar]
  12. AgharaziM. GazeraniS. HuntingtonM.K. Topical turmeric ointment in the treatment of diabetic foot ulcers: A randomized, placebo-controlled study.Int. J. Low. Extrem. Wounds202210.1177/1534734622114322236514270
    [Google Scholar]
  13. AbdoliA. ShahbaziR. ZoghiG. DavoodianP. KheirandishS. AzadM. KheirandishM. The effect of topical olive oil dressing on the healing of grade 1 and 2 diabetic foot ulcers: An assessor-blind randomized controlled trial in type 2 diabetes patients.Diabetes Metab. Syndr.2022161210267810.1016/j.dsx.2022.10267836459908
    [Google Scholar]
  14. NarzaryI. SwarnakarA. KalitaM. MiddhaS.K. UshaT. BabuD. MochaharyB. BrahmaS. BasumataryJ. GoyalA.K. Acknowledging the use of botanicals to treat diabetic foot ulcer during the 21st century: A systematic review.World J. Clin. Cases202311174035405910.12998/wjcc.v11.i17.403537388781
    [Google Scholar]
  15. BoultonA.J.M. ArmstrongD.G. KirsnerR.S. AttingerC.E. LaveryL.A. LipskyB.A. MillsJ.L. SteinbergJ.S. Diagnosis and management of diabetic foot complications.ADA Clin. Compendia20182201810.2337/db20182‑130958663
    [Google Scholar]
  16. BoultonA.J.M. ArmstrongD.G. HardmanM.J. MaloneM. EmbilJ.M. AttingerC.E. LipskyB.A. Aragón-SánchezJ. LiH.K. SchultzG. KirsnerR.S. Diagnosis and management of diabetic foot infections.ADA Clin. Compendia20202020110.2337/db2020‑0132105420
    [Google Scholar]
  17. BoultonA.J.M. ArmstrongD.G. LöndahlM. FrykbergR.G. GameF.L. EdmondsM.E. OrgillD.P. KramerK. GurtnerG.C. JanuszykM. VileikyteL. New evidence-based therapies for complex diabetic foot wounds.ADA Clin. Compendia20222022212310.2337/db2022‑0235763580
    [Google Scholar]
  18. AminiM.R. AalaaM. Nasli-EsfahaniE. AtlasiR. SanjariM. NamaziN. The effects of dietary/herbal supplements and the serum levels of micronutrients on the healing of diabetic foot ulcers in animal and human models: A systematic review.J. Diabetes Metab. Disord.202120197398810.1007/s40200‑021‑00793‑434178870
    [Google Scholar]
  19. de SousaG.P. FonteneleM.K.A. da RochaR.B. CardosoV.S. Update of topical interventions for healing diabetic ulcers - A systematic review.Int. J. Low. Extrem. Wounds202322222223410.1177/1534734621101318933949242
    [Google Scholar]
  20. KumarS. BharaliA. SarmaH. KushariS. GamS. HazarikaI. PrasadS.K. LalooD. Traditional complementary and alternative medicine (TCAM) for diabetic foot ulcer management: A systematic review.J. Ayurveda Integr. Med.202314410074510.1016/j.jaim.2023.10074537441954
    [Google Scholar]
  21. HigginsJ.P.T. AltmanD.G. SterneJ.A.C. 2017Assessing risk of bias in included studies.Cochrane Handbook for Systematic Reviews of Interventions: Cochrane Book Series18724110.1002/9780470712184.ch8
    [Google Scholar]
  22. JacobsA.M. TomczakR. Evaluation of Bensal HP for the treatment of diabetic foot ulcers.Adv. Skin Wound Care2008211046146510.1097/01.ASW.0000323573.57206.7b18836324
    [Google Scholar]
  23. TonacoL.A.B. GomesF.L. Velasquez-MelendezG. LopesM.T.P. SalasC.E. The Proteolytic fraction from latex of vasconcellea cundinamarcensis (P1G10) enhances wound healing of diabetic foot ulcers: A double-blind randomized pilot study.Adv. Ther.201835449450210.1007/s12325‑018‑0684‑229564750
    [Google Scholar]
  24. CarvalhoA.F. FeitosaM.C. CoelhoN.P. RebêloV.C.N. CastroJ.G.D. de SousaP.R.G. FeitosaV.C. ArisawaE.A.L.S. Low-level laser therapy and Calendula officinalis in repairing diabetic foot ulcers.Rev. Esc. Enferm. USP504201662863410.1590/S0080‑62342016000050001327680049
    [Google Scholar]
  25. DuL. ZengD. HuX. RenX. HeD. The efficacy of autologous platelet-rich gel and traditional chinese medicine in diabetic foot treatment: A parallel randomized controlled clinical trial.Ann. Vasc. Surg.20228752953710.1016/j.avsg.2022.07.02636064130
    [Google Scholar]
  26. IraniP.S. RanjbarH. Mehdipour-RaboriR. TorkamanM. AmirsalariS. Alazmani-NoodeF. The effect of aloe vera on the healing of diabetic foot ulcer: A randomized, double-blind clinical trial.Curr. Drug Discov. Technol.2023213566310.2174/157016382066623090415094537670716
    [Google Scholar]
  27. KarimiZ. BehnammoghadamM. RafieiH. AbdiN. ZoladlM. TalebianpoorM.S. AryaA. KhastavanehM. Impact of olive oil and honey on healing of diabetic foot: A randomized controlled trial.Clin. Cosmet. Investig. Dermatol.20191234735410.2147/CCID.S19857731190942
    [Google Scholar]
  28. KuoY.S. ChienH.F. LuW. Plectranthus amboinicus and Centella asiatica cream for the treatment of diabetic foot ulcers.Evid. Based Complement. Alternat. Med.201220121910.1155/2012/41867922693530
    [Google Scholar]
  29. MohajeriG. SafaeeM. SaneiM.H. Effects of topical Kiwifruit on healing of neuropathic diabetic foot ulcer.J. Res. Med. Sci.2014196520524[PMID: 25197293
    [Google Scholar]
  30. BahramiA. KamaliK. Ali-AsgharzadehA. Clinical application of oral form of ANGIPARSTM and in combination with topical form as a new treatment for diabetic foot ulcers: A randomized clinical trial.Daru200816Suppl. 14148
    [Google Scholar]
  31. BarbosaM. CarvalhoV. PaggiaroA. Hydrogel enriched with sodium alginate and vitamins A and E for diabetic foot ulcer: A randomized controlled trial.Wounds202234922923510.25270/wnds/2010336219460
    [Google Scholar]
  32. GallelliG. CioneE. SerraR. LeoA. CitraroR. MatricardiP. Di MeoC. BiscegliaF. CaroleoM.C. BasileS. GallelliL. Nano‐hydrogel embedded with quercetin and oleic acid as a new formulation in the treatment of diabetic foot ulcer: A pilot study.Int. Wound J.202017248549010.1111/iwj.1329931876118
    [Google Scholar]
  33. JudeE.B. ApelqvistJ. SpraulM. MartiniJ. Prospective randomized controlled study of Hydrofiber® dressing containing ionic silver or calcium alginate dressings in non‐ischaemic diabetic foot ulcers.Diabet. Med.200724328028810.1111/j.1464‑5491.2007.02079.x17305788
    [Google Scholar]
  34. ChokpaisarnJ. ChusriS. VoravuthikunchaiS.P. Clinical randomized trial of topical Quercus infectoria ethanolic extract for the treatment of chronic diabetic ulcers.J. Herb. Med.20202110030110.1016/j.hermed.2019.100301
    [Google Scholar]
  35. LiS. ZhaoJ. LiuJ. XiangF. LuD. LiuB. XuJ. ZhangH. ZhangQ. LiX. YuR. ChenM. WangX. WangY. ChenB. Prospective randomized controlled study of a Chinese herbal medicine compound Tangzu Yuyang Ointment for chronic diabetic foot ulcers: A preliminary report.J. Ethnopharmacol.2011133254355010.1016/j.jep.2010.10.04021129474
    [Google Scholar]
  36. NasiriM. FayaziS. JahaniS. YazdanpanahL. HaghighizadehM.H. The effect of topical olive oil on the healing of foot ulcer in patients with type 2 diabetes: A double-blind randomized clinical trial study in Iran.J. Diabetes Metab. Disord.20151413810.1186/s40200‑015‑0167‑925969821
    [Google Scholar]
  37. Romero-CereceroO. ZamilpaA. TortorielloJ. Effectiveness and tolerability of a standardized extract from Ageratina pichinchensis in patients with diabetic foot ulcer: A randomized, controlled pilot study.Planta Med.201581427227810.1055/s‑0034‑139631525714724
    [Google Scholar]
  38. NajafianY. KhorasaniZ.M. NajafiM.N. HamediS.S. MahjourM. FeyzabadiZ. Efficacy of Aloe vera/plantago major gel in diabetic foot ulcer: A randomized double-blind clinical trial.Curr. Drug Discov. Technol.201916222323110.2174/157016381566618011509300729336265
    [Google Scholar]
  39. GardnerS.E. HillisS.L. FrantzR.A. A prospective study of the PUSH tool in diabetic foot ulcers.J. Wound Ostomy Continence Nurs.201138438539310.1097/WON.0b013e31821e4dbd21606864
    [Google Scholar]
  40. HarrisC. Bates-JensenB. ParslowN. RaizmanR. SinghM. KetchenR. Bates-Jensen wound assessment tool: Pictorial guide validation project.J. Wound Ostomy Continence Nurs.201037325325910.1097/WON.0b013e3181d73aab20386331
    [Google Scholar]
  41. TanG. JensenM.P. ThornbyJ.I. ShantiB.F. Validation of the brief pain inventory for chronic nonmalignant pain.J. Pain20045213313710.1016/j.jpain.2003.12.00515042521
    [Google Scholar]
  42. DuttaA. BhansaliA. RastogiA. Early and intensive glycemic control for diabetic foot ulcer healing: A prospective observational nested cohort study.Int. J. Low. Extrem. Wounds202322357858710.1177/1534734621103345834279130
    [Google Scholar]
  43. LaneK.L. AbusamaanM.S. VossB.F. ThurberE.G. Al-HajriN. GopakumarS. LeJ.T. GillS. BlanckJ. PrichettL. HicksC.W. ShermanR.L. AbularrageC.J. MathioudakisN.N. Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies.J. Diabetes Complications2020341010763810.1016/j.jdiacomp.2020.10763832527671
    [Google Scholar]
  44. KhanM.S. AzamM. KhanM.N. SyedF. AliS.H.B. MalikT.A. AlnasserS.M.A. AhmadA. KarimullaS. QamarR. Identification of contributing factors, microorganisms and antimicrobial resistance involved in the complication of diabetic foot ulcer treatment.Microb. Pathog.202318410636310.1016/j.micpath.2023.10636337730169
    [Google Scholar]
  45. KanberE.M. GulmezH. Factors affecting platelet-rich plasma success in patients with diabetic foot ulcer.Cureus2023156e4080310.7759/cureus.4080337485222
    [Google Scholar]
  46. PereiraM.G. VilaçaM. BragaD. MadureiraA. Da SilvaJ. SantosD. CarvalhoE. Healing profiles in patients with a chronic diabetic foot ulcer: An exploratory study with machine learning.Wound Repair Regen.202331679380310.1111/wrr.1314138073283
    [Google Scholar]
  47. GreeneT. Randomized controlled trials 6: Determining the sample size and power for clinical trials and cohort studies.Methods Mol. Biol.2021224928130510.1007/978‑1‑0716‑1138‑8_1633871850
    [Google Scholar]
  48. Melguizo-RodríguezL. de Luna-BertosE. Ramos-TorrecillasJ. Illescas-MontesaR. Costela-RuizV.J. García-MartínezO. Potential effects of phenolic compounds that can be found in olive oil on wound healing.Foods2021107164210.3390/foods1007164234359512
    [Google Scholar]
  49. WangS. QiuY. ZhuF. Kiwifruit (Actinidia spp.): A review of chemical diversity and biological activities.Food Chem.202135012846910.1016/j.foodchem.2020.12846933485721
    [Google Scholar]
  50. PratamaV. RisniH.W. YunirE. SauriasariR. A systematic review of randomized controlled trials of antibiotic use in diabetic foot ulcer infections: Focus on clinical cure.Infect. Chemother.202254112513910.3947/ic.2021.014435384424
    [Google Scholar]
  51. ArmstrongD.G. BoultonA.J.M. BusS.A. Diabetic foot ulcers and their recurrence.N. Engl. J. Med.2017376242367237510.1056/NEJMra161543928614678
    [Google Scholar]
/content/journals/npj/10.2174/0122103155331492241025083322
Loading
/content/journals/npj/10.2174/0122103155331492241025083322
Loading

Data & Media loading...

Supplements

PRISMA checklist is available as supplementary material on the publisher’s website along with the published article.

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test