Assessment of the CO2 water bath therapy effectiveness on diabetic foot ulcers through VEGF and TNF-α levels

Vasculopathy is typically seen in diabetic patients, and can lead to foot ulcerations. Carbon dioxide (CO2) therapy was found to improve chronic wound healing in patients with vascular impairment. This type of therapy refers to the transcutaneous and subcutaneous application of CO2 as well as CO2 water baths for therapeutic purposes. In the method used herein, artificial CO2-containing water for foot bathing was generated by dissolving Carbothera® (MRE-SPA-MD; Mitsubishi Rayon Engineering, Tokyo, Japan) and generating CO2 (free CO2 concentration: 1,000–1,200 mg/L; pH 4.6). The foot of each patient was immersed in CO2-enriched water (depth of 20–30 cm, 37–38°C, 30-min duration) three times per week, for the next three months. Dramatic clinical improvement was observed in the CO2 water bath therapy group before and after the treatment, while both the blood levels of the vascular endothelial growth factor and of the tumour necrosis factor-alpha in these patients exhibited significant changes. The advantages of this method are the absence of pain and the protection against infection, while the improved angiogenesis and oxygena¬tion can result in healing of the chronic wound.