HBOT - Diabetic foot wounds (DFU's)

What are Diabetic Foot Ulcers?

Diabetic Foot ulcers are chronic, complex, or problem wounds of the legs and feet in people with diabetes. Diabetic Foot Ulcers that do not heal within three months are usually considered Chronic and Non Healing. Research shows that approximately 15 percent of all diabetes patients will develop foot ulcers at some point in their lives.

People with diabetes are particularly susceptible to diabetic foot ulcers because diabetes can damage nerves in your legs and feet causing problems with your blood flow, which in turn delays the process of wound healing. 

What are the causes of Diabetic Foot Ulcers and Non Healing Diabetic Wounds?

Diabetic foot ulcers are caused by repetitive trauma or pressure on the foot that damage your skin. These problems can go unnoticed by people with Neuropathy (numbness in your feet) or Peripheral Vascular Disease (poor blood circulation in your legs). Diabetes, immobilization, chronic edema, and circulatory problems contribute to the majority of chronic, non-healing wounds. Other chronic wounds are the result of traumatic injury, non-healing surgical wounds etc. 
A lack of sufficient oxygen (hypoxia) in the wound bed slows or stops the normal healing process. Wound healing in people with diabetes is often complicated by poor blood circulation in the feet and legs. Diabetic Foot Ulcers are prone to serious bacterial infections that threaten life and limb. 

How one knows if  he/she  have Chronic, Non-Healing Wound?

If a wound has not improved significantly in four weeks or if it has not completed the healing process in eight weeks, it should be considered a Chronic Wound and a Non Healing wound. In some extreme cases, dead tissue builds up inside and around the ulcer, which requires surgery to remove – a procedure called debridement. And if blood flow becomes too restrictive, you may require bypass surgery to help re-open your arteries. Rarely, diabetic ulcers become too infected or severe to treat. 

As a last resort, amputation may be needed to stop the infection from spreading throughout the body. Half of amputations performed each year are related to diabetic wounds. 

Wound care specialists classify diabetic foot ulcers using the Wagner Grade Scale:

Grade 0: No open lesions, but may possess pre ulcerative lesions, healed ulcers, presence of bone deformity
Grade 1: Superficial ulcer, not involving subcutaneous tissue
Grade 2: Deep ulcer with penetration through the subcutaneous tissue, potentially exposing bone, tendon, ligament, or joint capsule
Grade 3: Deep ulcer with osteitis (bone inflammation), abscess (pus), or osteomyelitis (bone infection)
Grade 4: Gangrene of digit (toe)
Grade 5: Gangrene of foot requiring disarticulation (amputation)

How Hyperbaric Oxygen Therapy Helps in Healing Diabetic Foot Ulcers & Chronic Wounds?

Hyperbaric Oxygen Therapy (HBOT) is the process of breathing 100% oxygen in a carefully controlled, pressurized environment, resulting in increased oxygen delivery to the body tissues. At pressures greater than normal atmospheric pressure, the body is able to absorb more oxygen into blood cell, blood plasma, cerebral spinal and other body fluids. This increased oxygen activity enhances the body's ability to heal.

The increased oxygen tension in tissues supports physiologic wound healing, decreasing edema, enhances oxidative killing of bacteria, increasing cellular energy production, antibiotic potentiation, neoangionenesis promotion, enhanced epithelial migration, improved collagen production and granulation-tissue formulation. 

What is a Wound Healing Center or A Diabetic Foot Care Center?

Successful care of problem wounds requires an integrated team approach together with adjunct Hyperbaric Oxygen Therapy ( HBOT ) when appropriate. An ideal Foot Care center  or a diabetic wound healing center may have Podiatrists, Plastic and reconstructive surgeons, vascular surgeons, rehabilitation and hyperbaric physicians to work together as an integrated wound care team to cure problem wounds of the foot. 

Hyperbaric Oxygen Therapy ( HBOT) offers interdisciplinary outpatient care that is highly effective in healing wounds that resist conventional therapies such as : Complex soft tissue wounds, Diabetic foot ulcers, Arterial Ulcers, Venous stasis ulcers, Pressure ulcers, Trauma Wounds, Skin Grafts and Flaps, Necrotizing Soft Tissue Infections, Burns, Neuropathic Ulcers, Tissue Damage from Radiation etc.


Hyperbaric oxygen therapy when used as an adjunct treatment of modality can significantly improve morbidity and mortality, reduce length of hospital stay, reduces the need for surgical interventions, lessen the need for surgery or foot amputations, reduces treatments costs, improves quality of life… Saving Limbs & Lives. 
Hyperbaric oxygen Therapy (HBOT) is an effective adjunct to standard modalities for the treatment of diabetic foot ulcers used in the western world for over twenty years. 
In India Hyperbaric Oxygen Therapy (HBOT) has captured the interests of wound care givers and podiatrists as their counterparts in the western world and will become increasingly an adjunct treatment to provide healing care for Diabetic Foot Ulcers in diabetic patients.
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