Current Evidence on Ayurvedic Topical Therapies in the Management of Diabetic Foot Ulcers: A Comprehensive Review

Diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus and a leading cause of infection, hospitalization, lower-limb amputation, and impaired quality of life. Despite advances in conventional wound care, delayed healing, recurrent infection, antimicrobial resistance, and high treatment costs continue to compromise clinical outcomes. Ayurveda describes chronic non-healing wounds under the concept of Dushtavrana and advocates topical therapies with Shodhana (wound cleansing), Ropana (wound healing), Krimighna (antimicrobial), and Shothahara (anti-inflammatory) properties. Increasing scientific interest in traditional wound management has prompted evaluation of these interventions using contemporary research methods.

Objective: To critically review and synthesize the available evidence on Ayurvedic topical therapies for the management of diabetic foot ulcers, with emphasis on their therapeutic efficacy, pharmacological actions, clinical applications, and existing research gaps.

Methods: A comprehensive literature search was performed using PubMed, Scopus, Google Scholar, Cochrane Library, AYUSH Research Portal, DHARA, and IndMED. Peer-reviewed clinical studies, randomized controlled trials, observational studies, case reports, experimental investigations, and relevant classical Ayurvedic literature pertaining to topical therapies for diabetic foot ulcers and chronic wounds were reviewed. The evidence was narratively synthesized to evaluate clinical outcomes, proposed mechanisms of action, and methodological quality.

Results: Current evidence indicates that several Ayurvedic topical formulations, including Jatyadi Taila, Madhu, Nimba (Azadirachta indica), Haridra (Curcuma longa), Yashtimadhu (Glycyrrhiza glabra), and other polyherbal preparations, exhibit antimicrobial, anti-inflammatory, antioxidant, angiogenic, and wound-healing properties. Clinical and experimental studies suggest beneficial effects on wound debridement, granulation tissue formation, infection control, epithelialization, and overall healing. However, the available evidence is constrained by small sample sizes, heterogeneity in formulations and study designs, inadequate standardization, and limited high-quality multicenter randomized controlled trials.

Conclusion: Ayurvedic topical therapies demonstrate promising potential as adjunctive interventions in the management of diabetic foot ulcers. Integration of standardized Ayurvedic formulations with evidence-based conventional wound care may enhance wound healing and improve patient outcomes. Well-designed randomized controlled trials, standardized pharmaceutical protocols, mechanistic investigations, and long-term safety evaluations are required to strengthen the evidence base and facilitate their integration into contemporary diabetic wound management.