Can Copper Help Prevent Lower Extremity Complications In Patients With Diabetes?

Gary M. Rothenberg, DPM, CDE, CWS

   The researchers utilized a partial thickness porcine wound model for the study.4 They created 12 deep punch biopsy wounds (12 mm x 5 mm in diameter). They treated six of the wounds with the copper test dressing and the other six wounds with control commercial dressings. The study authors performed macro- and microscopic evaluations, and recorded results at day three and day seven after the wounds were created. Researchers concluded that the test dressing demonstrated a high broad-spectrum biocidal efficacy and was well tolerated without significant adverse event.

What The Research Reveals About The Benefits Of Copper In Socks

In a pilot in vivo study involving 56 patients, Zatcoff and co-workers found that the use of copper soled socks facilitated improvement in the common manifestations of tinea pedis including erythema, scaling, fissuring, burning, itching and vesicular eruptions.5 The study authors noted that no patients worsened or showed adverse reactions while wearing copper-oxide impregnated socks.

   Currently, there is technology that incorporates copper oxide in the manufacturing process of textiles such as socks. Given the demonstrated antimicrobial, antifungal and antiviral benchwork studies that researchers have done, introducing copper into fabrics may have significant clinical ramifications.

   Based on the strong in vitro data and some in vivo data, the Miami VA Healthcare System is currently involved in an IRB-approved multicenter study to provide evidence-based medicine on the possible efficacy and safety of using copper oxide impregnated socks as a preventative measure for diabetes-related lower limb and foot ulcers.

   Copper oxide may be easily incorporated into textiles such as socks as well as dressings. Copper oxide is the most naturally occurring and abundant form of copper available. Being a non-soluble compound, it allows a slow and steady release of copper in the presence of humidity and moisture, which is ideal for use in socks. Researchers have hypothesized that the antimicrobial and antifungal properties of the copper socks may decrease the incidence of itching. They may also help prevent cracks and fissures that may be part of the causal pathway leading from ulceration to secondary infection, and even amputation in the high-risk diabetic population.6 In the presence of peripheral neuropathy and vascular disease, often a simple skin breakdown or irritation can result in limb-threatening infections.

   In addition to exploring the use of copper textiles in the medical community, we have also seen the incorporation of copper textiles into the military sector. When copper technology is integrated into military clothing and footwear, it offers the additional potential antimicrobial and antifungal benefits as well as an improvement to skin appearance to those serving in the military. Veterans of the armed services throughout the world are exposed to harsh weather conditions and moisture immersion, and often do not have the ability to change footwear regularly.

   Cupron Medical produces copper infused socks and was recently selected by the Israel Defense Forces to supply antimicrobial socks. With this selection, the Israel Defense Forces became the first army in the world to supply its soldiers with antimicrobial socks based on the innovative copper-based technology.

Final Notes

There are exciting laboratory bench work studies currently being conducted to explore the scientific role copper may play in wound healing processes such as angiogenesis. Studies are also looking at the bactericidal and fungicidal properties of the element. There are also clinical studies such as our multicenter study that are exploring the preventive aspect and application of copper impregnated textiles.

   Why not add copper oxide to socks if there may be a strong prevention aspect? Could wound biopsies prove low local levels of copper that impair wound healing? Could supplementation with topical copper (and in what form) facilitate wound closure? The bridge between basic science and clinical relevance will hopefully prove to be beneficial for our high-risk patients in the near future.

   Dr. Rothenberg is the Director of Residency Training and is an Attending Podiatrist with the Miami Veterans Affairs Healthcare System.


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