Glyceryl trinitrate therapy for ischaemia, painful diabetic neuropathy, healing of foot ulceration and other podiatric conditions: a literature review

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Abstract

Glyceryl trinitrate is a substance that causes vasodilation
by donation of nitric oxide which causes relaxation of
the endothelium of blood vessel walls. The vasodilatory
effect of this substance has been known since 1870 and
it has been used extensively in the treatment of angina
via transdermal patches, sublingual tablets and sprays.
Studies involving normal vasculature as well as diseased
vascular states have been promising in terms of demonstrably
consistent and significant vasodilatory effects on
both systemic and peripheral systems. Podiatric application
for this pharmacologic intervention seems to have
received little attention in the literature to date. Its
efficacy in equine treatment of laminitis, an ischaemic
condition of the horses hoof has been well established
and researched. It has been applied to other clinical problems
involving perfusion of the extremities, such as
treatment of inability to achieve penile erection and use
in treatment of anal fissures. A literature search has produced
information on this drug which suggests potential
for greater application in clinical podiatry. This includes
positive effects in digital perfusion, which holds promise
for wound healing and shows potential for reducing
amputations associated with peripheral vascular disease
(PVD). This novel therapy has the potential to be useful
in cases with borderline vascular supply that require a
boost to perfusion to trigger the healing process and/-or
relieve other symptoms of ischaemia. It has also been
found to be of assistance in the management of painful
diabetic neuropathy (PND). This finding is of particular
interest as an adjunct to treatment for the prevalent and
difficult clinical challenge of PND. The literature
regarding its use in musculotendinous applications such
as for Achilles tendinopathy will also be covered in this
review. Potential issues with this drug including side
effects and tolerance will be addressed. Further study of
this treatment modality would be beneficial in terms of
determining specific indications and limitations of its
use, particularly for vascular insufficiency of the feet and
healing of foot ulceration.
Original languageEnglish
Article number4(Suppl 1):O28.
Number of pages1
JournalJournal of Foot and Ankle Research
Volume4(Suppl 1):O28.
Publication statusPublished - 20 May 2011

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