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About this Podcast:
About the guest:
Dr. David G. Armstrong, DPM, PhD, is a Podiatric surgeon at Keck Medicine of USC and Distinguished Professor of Surgery and Neurological Surgery at the Keck School of Medicine of USC. With a career spanning three decades, Dr. Armstrong’s expertise includes podiatric surgery, diabetic foot care, wound remission, and limb preservation.
He is the founder and co-director of the Southwestern Academic Limb Salvage Alliance (SALSA) and Director of USC’s NSF-funded Center to Stream Healthcare in Place (C2SHiP). He has also authored more than 720 peer-reviewed papers and over 120 books and book chapters and is a founding co-editor of the American Diabetes Association’s Clinical Care of the Diabetic Foot.
Episode overview:
In this episode of The Cure Circle, Dr. David G. Armstrong, DPM, PhD, discusses the future of diabetic foot ulcers and what it will take to move wound remission and limb preservation beyond conventional approaches. A conversation about regenerative medicine becomes a broader examination of how biology, technology, diagnostics, and clinical care need to come together.
The conversation focuses on a single question: If we can develop new ways to heal wounds, what will it take to make them work in practice?
The conversation then moves into regenerative approaches, including mesenchymal stromal cells, bone marrow-derived cells, adipose-derived cells, exosomes, secretomes, and engineered approaches. Dr. Armstrong discusses how these therapies may influence the wound environment and why the future may lie less in a single therapeutic product and more in combining different approaches.
Diagnostics become an important part of this discussion. The question is not only what treatment to use but also when to start it, when to stop it, and how to know whether it is working. Dr. Armstrong highlights the need for better companion diagnostics and “if this, then this” approaches that can help guide treatment decisions.
Ultimately, the conversation moves beyond wound closure to a bigger clinical goal: durable healing, long-term remission, and preventing the avoidable amputations that continue to affect people with diabetic foot disease.
In This Episode, Dr. Karpate and Dr. Armstrong Discuss:
- Why Diabetic Foot Wounds Become Chronic: What happens when normal wound-healing processes fail, and why diabetic foot wounds can become difficult to heal.
- The Fundamentals of Wound Care: Why removing barriers to healing, including unhealthy tissue and pressure, can be as important as what is added to the wound.
- Healing vs. Remission: Why closing a wound is not necessarily the end of treatment, and what recurrent wounds reveal about the need for long-term care.
- The Science of Regeneration: How mesenchymal stromal cells, bone marrow-derived cells, adipose-derived cells, exosomes, and secretomes could influence the wound-healing environment.
- When the Cell Is the Drug Delivery Vehicle: How researchers are exploring whether the therapeutic effects of cells can be achieved by delivering their biological signals directly.
- From Single Therapies to Combination Approaches: Why the future of regenerative wound care may involve combining cells, biologics, biomaterials, and other interventions rather than relying on one therapy.
- The Role of Companion Diagnostics: Why knowing which patient needs which therapy, when to start treatment, and when to stop it could be as important as developing the therapy itself.
- Beyond the Wound: Why effective diabetic foot care must also address factors such as ischaemia and infection alongside wound remission.
- The Value of the Team: Why multidisciplinary collaboration between clinicians, researchers, engineers, and other specialists is essential to solving complex problems in diabetic foot disease.
- What Comes Next in Regenerative Wound Care: Which emerging approaches show promise and what researchers need to focus on to move regenerative therapies towards meaningful clinical outcomes and fewer preventable amputations.
