Could Diabetic Foot Ulcers Benefit from Topical or Oral Probiotics?
As foot and ankle surgeons are increasingly managing complex diabetic foot wounds, emerging adjunctive therapies may offer new avenues to improve outcomes. A systematic review, presented as an abstract at the 2025 ACFAS ASC, evaluated the role of probiotics in promoting healing of diabetic foot ulcers (DFUs), evaluating a complementary strategy to traditional wound care.
Conducted in accordance with PRISMA guidelines, the authors analyzed studies sourced from PubMed, Google Scholar, and the Cochrane Library up to September 2024. Inclusion criteria focused on clinical studies that assessed the use of probiotics in the treatment of DFUs, excluding animal, cadaveric, and other systematic reviews. A novel metric, percent reduction of ulcer surface area per day (PRUSA/day), was used to assess healing rates, with statistical comparisons made via one-tailed weighted ANOVA and Tukey’s post-hoc testing.1
Out of 6,123 screened articles, only four met the criteria, totaling 105 ulcers across three randomized controlled trials and one case report. Topical probiotics were examined in three studies and oral probiotics in one. The average PRUSA/day was highest in the topical probiotic group (1.21%), compared to oral probiotics (0.97%) and controls (0.83%). The ANOVA test yielded statistical significance (P=0.04), with Tukey’s post-hoc analysis indicating that topical probiotics had a mildly significant advantage over standard care.1
The findings the authors presented support the concept that restoring microbiome balance through probiotics—particularly topical formulations—may enhance wound healing in diabetic patients, who often suffer from dysbiotic skin flora. While promising, they note that these results are based on limited data and small sample sizes, emphasizing the need for larger, well-controlled trials. In summary, probiotics, especially in topical form, may serve as a beneficial adjunct to conventional DFU management based of the results of this review.
Reference
1. Matichak ME, Webb BM, Callard DL, Merkel PJ. Topical and oral probiotics as an adjunctive therapy for diabetic foot ulcers: a systematic review with meta-analysis. Abstract presented at the American College of Foot and Ankle Surgeons' Annual Scientific Conference, March 26-28, 2025, Phoenix, AZ.
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