Discussion

In this case report, we present the successful treatment of a high-risk diabetic foot ulcer in an older adult using ozone therapy and collagen powder. The patient’s comorbidities, including uncontrolled diabetes mellitus and severe heart failure, precluded surgical management, necessitating a non-surgical approach in an outpatient setting.
Diabetic foot ulcers are a life-threatening and debilitating complication of advanced diabetes, often resulting in amputations and substantial socio-psychological burden for patients. Prevention is a key component of diabetic foot ulcer management (4). Additionally, managing underlying diabetes is crucial to prevent further microvascular changes and decrease the recurrence rate. Conventional treatment methods for diabetic foot ulcers have had limited success, highlighting the need for new and innovative approaches (5).
While local muscle flaps are the preferred option for small foot and ankle ulcers with exposed bone or tendon, non-surgical approaches can serve as an alternative, especially when patients have comorbidities. Soft tissue defects involving tendons in the foot and ankle present challenges in healing due to limited availability of epithelial cells and lack of soft tissue coverage, further compounded by additional comorbidities such as severe heart failure (6).
Ozone therapy has emerged as a potential treatment modality in recent years. Possible mechanisms associated with wound healing in ozone therapy include antibacterial effects, growth factor release, and tissue oxygenation (7). However, improper application of ozone therapy can lead to respiratory tract damage, gastrointestinal symptoms, and headaches (8).
The use of ozone therapy in diabetic foot ulcers remains controversial, and its safety and efficacy have not been extensively investigated. Previous case reports utilizing ozone therapy for diabetic foot ulcer management have shown positive results, but these studies used different methods such as ozone bagging (9, 10). In our case, we utilized ozone therapy by tent.
A study by Kadir et al. showed that ozone therapy as an adjunct to standard treatment did not significantly impact the healing process but did reduce bacterial infections (11). Additionally, Uzun et al. reported a case in which intralesional ozone injection resulted in severe foot infection and necrosis, suggesting the potential risks of ozone therapy (12). However, it is important to note that the patient in the Uzun et al. study had poor adherence to diabetes treatment, which may have contributed to the negative outcome.
Conclusion:
In conclusion. Critical tendon exposed diabetic foot ulcers can be healed rapidly by ozone therapy and collagen powder. Consequently, preventing tendon loss and further complications is more convenient when the healing process is faster. The authors recommend additional research in this area to better understand the wound healing process in diabetic foot ulcers and to determine the optimal use of ozone therapy as a non-surgical treatment option.
Declarations:
  1. Ethical approval and consent to participant A written informed consent was obtained from the next of kin. Authors confirm that all methods were performed in accordance with institutional ethical standards and Declarations of Helsinki.
  2. Consent for publication A written informed consent for publicly reporting the information of the condition was obtained from the participant.
  3. Availability of data and materials All data are available from the corresponding author on reasonable request.
  4. Competing interests All the authors declared no conflict of interest.
  5. Funding This article was no funded by any individual or organization.
  6. Authors’ contributions Study conception and review of the Literature: HMT, MSF, JJ. Clinical management: HMT. Manuscript preparation: HMT, MSF. Supervision, Administrative support and critical revision of the paper: JJ. All authors read and approved the final manuscript.
  7. Acknowledgment
  8. we would like to extend our sincere thanks to Dr. Maryam Jenabi, Dr. Sahba Sheikholeslami and Dr. Sophia Emamdoost for helping us with material supports.
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