Quantifying the efficacy of a simple, non-invasive diabetic foot treatment technique

Every year across the world, more than 18 million people suffer from diabetic foot (DF), a leading cause of amputations, making the prompt treatment of insufficient blood circulation critical. Conventional surgical revascularization methods, however, are often insufficient for improving lower-extremity hemodynamics. Alternatively, several exercise-based techniques have emerged, including enhanced external counterpulsation (EECP), which involves inflatable cuffs that create pressure to help blood flow.

Yet little research has supported the efficacy of this technique for improving leg circulation, especially in the small vasculature below the knee, in DF patients.

Wu et al. evaluated EECP-induced hemodynamics in six DF patients to quantify the technique with in vivo measurements and numerical simulations. The researchers developed patient-specific numerical models to assess the variation of hemodynamic metrics before and during EECP treatment, based on actual medical data.

“We measured their leg blood flow using Doppler ultrasound, and built personalized 3D models of their femoral arteries based on MRI scans,” said author Jianhang Du. “Using computational simulations, we were able to analyze how blood flow and key mechanical forces inside the vessels changed before and during EECP.”

They also validated the numerical model to guarantee the results, which were very promising: EECP was shown to significantly improve leg circulation, increasing both forward and backward blood flow.

“More importantly, we saw improvements in wall shear stress, which is a key mechanical factor linked to blood vessel health,” said Du. “EECP increased average shear stress and reduced harmful low-shear regions, often associated with disease progression.”

The researchers expect their study to promote the clinical application of EECP therapy in DF management, and provide theoretical bases for developing future therapies and devices.

Source: “Enhanced external counterpulsation treatment improves lower extremity hemodynamics and wall shear stress metrics in diabetic foot,” by Zi’an Wu, Xinjie Lin, Xuelian Shen, Jun Hu, Shuguang Peng, Wenjuan Zhou, Ziqian Mo, Changlong Bi, Runhua Zhou, and Jianhang Du, Physics of Fluids (2025). The article can be accessed at https://doi.org/10.1063/5.0284548 .