Botox for foot wounds

Each year, foot ulcers lead to more than 82,000 amputations. They're a devastating complication of diabetes.

"Every time you have an ulcer, this is just one more opportunity to develop a limb-threatening infection that might require an amputation," says Jeffrey Johnson, M.D., an orthopedic foot and ankle surgeon from Barnes-Jewish Hospital at Washington University School of Medicine in St. Louis.

Researchers at Washington University say healing the ulcers is tough, but keeping them healed is tougher.

Dr. Johnson says: "The problem is the recurrence rate is very high. Within the first month after healing these ulcers ... 60 percent or 80 percent of patients will re-ulcerate during that time."

Now, researchers are turning to Botox -- a poison that's commonly used to treat wrinkles.

Wounds are most common on the ball of the foot, and the pressure on wounds is highest when a person walks. That's where Botox comes in.

"What the botulism will do is weaken that muscle, the muscle that pushes you forward during walking, and so then you can't develop the high pressures under the front of your foot," says Mary Hastings, a physical therapist at Washington University who is leading the study.

Botox allows time for the ulcer to heal.

In a new study, doctors will inject Botox in six different places in the calf muscle.

Then, they'll cast it. They know the Botox will weaken the muscle, and they hope that's enough to keep the wounds healed.

"The more time you spend without a sore on the bottom of the foot, the less chance you have for an infection that will develop into the potential for a need for an amputation," Hastings says.

The study has already started enrolling patients. And for the more than 18 million diabetics in the Unites States, that's encouraging news.

Botox is already approved by the FDA to treat other medical conditions. Hastings says this is the first time Botox has been used for foot wounds.

Background information:

BACKGROUND: Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. No one knows the cause of diabetes, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. About 18 million Americans have diabetes. While about 13 million have been diagnosed with diabetes, researchers estimate about 5.2 million other people (or nearly one-third) do not know they have the disease.

THE ROLE OF THE NERVES: Sometimes, diabetes can lead to a complication known as neuropathy. Neuropathy occurs when the body loses function of the nerves. It starts at the fingertips and the tips of the toes first and works its way through the body. Jeffrey Johnson, M.D., from Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, says: "The feet are the most affected first … Usually what happens is you actually lose the feeling, the sensibility of the skin. So, you might have a rock in your shoe and not actually feel the rock because of the loss of feeling." Patients with neuropathy typically experience numbness, tingling and shooting pains.

FOOT ULCERS: Sometimes, neuropathy can lead to foot ulcers. Foot ulcers are a breakdown of the skin on the bottom of the foot. About 15 percent of patients with diabetes will develop a foot ulcer at some point. Dr. Johnson says: "Once you get neuropathy, the areas of high pressure on your foot are prone to breakdown. Patients don't feel the high pressure on their skin, and they will just go through normal daily activities, will develop a sore as the skin basically breaks down from the excessive pressure." Wounds are most common on the ball of the foot, and the pressure on wounds is highest when a person walks. In extreme cases, if the ulcer does not heal, doctors may have to amputate the foot.

AN EASIER SOLUTION: Researchers from Washington University in St. Louis are studying whether Botox -- a poison commonly used to treat wrinkles -- can help patients with foot ulcers. In a new study, the researchers will inject Botox in six different places on the calf muscle and then cast it. Mary Hastings, Ph.D., from Washington University, says, "What the botulism (Botox) will do is weaken the muscle, the muscle that pushes you forward during walking, and so then you can't develop the high pressures on the front of your foot." That will allow time for the ulcer to heal. Dr. Johnson says, "The treatment is basically designed to offload the area of the ulcer so that the body's own healing mechanisms can work." Botox is already approved by the FDA to treat other medical conditions. Researchers say this is the first time the drug has been used for foot wounds.

•	Botox for foot wounds News 14 Carolina online (Raleigh, North Carolina), Monday, July 18, 2005 Byline: Ivanhoe Newswire

	Story also ran in 1 others:  WTVF-TV Nashville TN