Is HBOT Therapy the Answer to Faster Healing for Diabetic Foot Ulcers?

Hyperbaric oxygen therapy (HBOT) has been shown to be an effective treatment for diabetic foot ulcers (DFUs), which involves patients breathing 100% pure oxygen from a hyperbaric chamber with the goal of filling the blood with enough oxygen to repair tissues. Wounds are damaging to blood vessels, so they release fluid that leaks into the tissues and causes swelling. HBOT floods the tissues with oxygen and reduces the swelling. This disrupts the cycle of tissue swelling, oxygen starvation, and tissue necrosis.

Benefits of HBOT for Diabetic Foot Ulcers

DFUs are open sores that characteristically form on the bottom of a diabetic’s foot and can be slow to heal, and are the result of poor circulation, a weak immune system among other factors. A number of studies have shown that HBOT is an effective treatment for diabetic ulcers by increasing the oxygen that is distributed to the tissue in an effected area, reducing the risk of infection while promoting quicker healing. Throughout the natural process of wound healing, the body employs oxygen to stimulate the growth of new tissue. By encouraging the formation of new blood vessels around the wound, HBOT boosts the delivery of oxygen to the affected area. As a result, the influx of oxygen and other essential healing nutrients promotes the creation of new, healthy tissue. HBOT should be avoided with Wagner Grade 2 or lower diabetic foot ulcers as there is very low evidence of effectiveness, and doctors typically only recommend HBOT when a diabetic foot ulcer is classified as Wagner grade 3 or higher.

A 2023 article on the debate between HBOT vs topical oxygen talked about an advantage of topical oxygen therapy to treat DFUs its ability to deliver molecular oxygen directly to the surface of the open wound, thereby accelerating granulation and epithelialization. This therapy has been shown to be effective in numerous case series, retrospective reviews, RCTs, systematic reviews, and meta-analyses – and despite its efficacy, it was noted this treatment modality is underutilized when compared to HBOT.

Some of the key benefits of HBOT for diabetic foot ulcers include:

  • Improved healing and risk of infection – The elevated levels of oxygen delivered through HBOT can help to kill bacteria and reduce the risk of infection in the affected area while helping promote the development of new blood vessels, which improves circulation while speeding up the healing process
  • HBOT has been shown to be effective in reducing pain associated with diabetic foot ulcers
  • Risk of amputation is reduced – HBOT encourages healing and reduces the risk of infection, HBOT lessening the risk of amputation in people with diabetic foot ulcers

Risks and Possible Complications of HBOT for Diabetic Foot Ulcers

While generally considered safe, there are some potential risks and side effects associated with HBOT treatment, including:

  • Damage to the ears and pain or discomfort in the sinuses, which are the most common side effects, resulting from the pressurized environment
  • Damage to the lungs and eyes, patients with pre-existing conditions are more susceptible
  • Claustrophobia: Patients who are claustrophobic or have claustrophobic tendencies can find the HBOT chamber uncomfortable and in some cases intolerable

Most side effects are usually minor and can be avoided by keeping the treatments to under two hours and not pressurizing the chamber more than three times that of normal pressure.

Alternative Treatments for Diabetic Foot Ulcers

HBOT has been shown to be effective in treating diabetic foot ulcers, however there are a number of alternate treatments to consider that may be beneficial for people with this condition.

  • Wound care/debridement, which includes cleaning the wound and removing necrotic tissues
  • Relieving pressure on the wound with a total contact cast
  • Antibiotics can be prescribed, reducing the risk of infection
  • Hydrogels offer a unique potential for the development of effective DFU dressings due to their remarkable capacity to retain oxygen, absorb wound exudate, and maintain a moist environment that facilitates normal physiological processes in the wound bed
  • The novel macrophage-regulating drug, ON101, showed significant efficacy in promoting complete wound healing and represents a groundbreaking treatment for DFUs

HBOT is an effective and safe treatment for diabetic foot ulcers that can help to promote healing, reduce pain, and improve overall quality of life. However, it is not the only option for patients with DFUs. Diabetic foot ulcers (DFUs) can be challenging, and using a patient centered approach is needed to achieve the best outcomes.