Utility of topical timolol in the management of chronic non-healing foot ulcers

Background: Chronic foot ulcers often do not respond to conventional therapy and result in amputations. Treatment is protracted, expensive and affects the quality of life of the patient. The objective of the study is the efficacy of topical timolol in the treatment of chronic non-healing foot ulcers and the feasibility of its use in a rural/semi-urban population. Methods: An observational, cross-sectional study was conducted at a tertiary hospital situated on the outskirts of Bengaluru from January 2021 to July 2022. Sample size was 95. Topical timolol maleate solution was applied on day 1, 3 and 7 and followed up on days 15 and 30. During each visit the wound was assessed and the area of ulcer was measured. Repeated measures ANOVA was applied to compare the area of ulcer on day 1, 15 and 30 and mean percentage of reduction calculated at different time intervals using post-hoc Bonferroni. Results: Demographic data: predominantly male (61.1%), mean age 48.74±14.8 years, from lower socioeconomic background. 45.3% were diabetics. Efficacy of timolol: mean ulcer area on day 1, 15 and 30 was 70.95, 51.8 and 39.95 cm2 respectively (p=0.001). There was a significant reduction in mean percentage of ulcer area on day 15 and day 30 (p=0.001). No adverse effects due to timolol were observed. Conclusions: Topical timolol is safe, inexpensive and effective. Its use in the treatment of chronic non-healing foot ulcers would be beneficial to a country like India which has a large rural population.