Hypochlorous Acid in Chiropody: Addressing Persistent Challenges in Foot Care

Foot specialists frequently encounter cases involving chronic foot wounds or post-surgical sites that are slow to heal and prone to infection¹⁻⁴. Managing such wounds requires an antimicrobial agent capable of eradicating infection while preserving healthy tissue¹⁻⁴. Hypochlorous acid (HOCl) has emerged as a potent and biocompatible antiseptic, offering an effective solution for foot and wound cleansing in chiropody⁵⁻¹². This article outlines the properties, clinical applications, and comparative advantages of HOCl in the management of diabetic foot ulcers (DFUs) and post-surgical nail procedures.

Hypochlorous Acid is a Natural Antimicrobial Agent

Hypochlorous acid is a weak acid produced naturally by human neutrophils during the immune response¹². Unlike traditional chlorine-based disinfectants, medical-grade HOCl is pH-neutral and highly biocompatible⁵⁻¹². It exhibits broad-spectrum antimicrobial activity against bacteria, bacterial spores, fungi, and viruses without cytotoxic effects on human cells at therapeutic concentrations¹². Studies have demonstrated its rapid efficacy in inactivating and reducing pathogens such as Staphylococcus aureus (including MRSA biofilms)¹³, Pseudomonas aeruginosa¹⁴, and Candida albicans species¹⁵, making it a valuable agent in clinical wound management¹².

Clinical Applications of HOCl in Chiropody

Diabetic Foot Ulcers: Infection Control and Wound Healing

The management of DFUs is complicated by impaired circulation, neuropathy, and the presence of multidrug-resistant organisms¹,³,⁷ Traditional antiseptics, while effective against microorganisms, often cause collateral tissue damage, impeding the healing process⁷⁻¹². In contrast, HOCl provides robust antimicrobial action without cytotoxicity, supporting the natural healing of granulating tissue⁷⁻¹². Research indicates that HOCl disrupts bacterial biofilms and reduces wound bioburden significantly, facilitating cleaner wound beds and promoting re-epithelialization⁷⁻¹⁵. In one comparative study of infected diabetic foot ulcers, hypochlorous acid (HOCl) demonstrated superior antimicrobial efficacy—particularly against Gram-negative bacteria—and significantly enhanced wound healing outcomes compared to povidone-iodine (PVP-I)¹⁷.

Nail Procedures and Surgical Aftercare: Enhancing Recovery

Minor foot surgeries, such as partial or total nail avulsions and lesion excisions, require meticulous postoperative wound care to prevent infection⁴. HOCl serves as an effective preoperative and postoperative skin antiseptic, matching or surpassing the antimicrobial efficacy of traditional antiseptics, such as povidone-iodine, without causing irritation or staining¹¹⁻¹². Postoperatively, HOCl is applied directly to surgical sites, promoting a clean environment conducive to healing¹¹⁻¹². Its pH neutrality and tissue compatibility minimize patient discomfort and facilitate compliance with wound care instructions¹¹⁻¹².

Clinical evidence indicates that the use of hypochlorous acid (HOCl) in postoperative wound care is associated with reduced infection rates, accelerated resolution of inflammation, and enhanced patient satisfaction¹¹⁻¹². In a comparative study, HOCl demonstrated a significant reduction in postoperative wound closure failure, with only 25% of patients in the HOCl-treated group experiencing closure failure compared to 80% in the sterile saline group¹⁶.

Comparing HOCl Against Traditional Antiseptics

1. Efficacy HOCl exhibits broad-spectrum antimicrobial properties comparable to traditional agents such as povidone-iodine, chlorhexidine gluconate (CHG), hydrogen peroxide, and isopropyl alcohol, integral to wound healing processes⁵⁻¹².
2. Tissue Toxicity Unlike these traditional antiseptics, which are often cytotoxic—meaning, damaging to healthy healing tissue—impeding wound healing, pure and stable HOCl is completely non-cytotoxic and supports fibroblast viability and epithelialization⁵⁻¹². This attribute allows for liberal and continuous application without risk of hindering wound repair⁵⁻¹².
3. Practical Advantages HOCl is clear, non-staining, and odour-free, thereby simplifying clinical application and improving the aesthetic and practical aspects of wound management¹¹. Its ability to disrupt biofilms further enhances its utility in treating chronic and infected wounds¹º⁻¹⁷.

Implementation Considerations for Chiropodists

• Frequent Application: HOCl can be applied liberally and frequently if needed, without risk of tissue damage.
• No Rinsing Required: HOCl remains active upon application, without the need for saline rinsing post-application.
• Storage: HOCl solutions should be stored away from sunlight in cool or room-temperature environments and used within manufacturer-recommended timeframes after opening.
• Formats: Available as sprays, irrigation solutions, and gels, hypochlorous acid offers several versatile application methods.
• Patient Education: Clear instructions on liberal and consistent use promote optimal outcomes.

Hypochlorous Acid Represents a Step Towards Advanced Foot Care

Hypochlorous acid represents a significant advancement in chiropody by offering an antimicrobial agent that combines efficacy with tissue safety⁵⁻¹⁷. Its role in enhancing the healing of diabetic foot ulcers and surgical wounds positions it as a preferred antiseptic for foot care specialists⁵⁻¹⁷. Incorporating HOCl into clinical protocols can improve healing outcomes, reduce infection rates, and enhance patient comfort, aligning with best practices in modern wound management⁵⁻¹⁷.