Many patients with diabetes develop skin ulcers on the feet.  The wounds are most often found by the sole of the foot and around the heel. Bacteria can cause an infection through small cracks (fissures) that can develop in the dry skin around the heel and on other parts of the foot.  The fissures also can occur through corns, calluses, blisters, hangnails, or ulcers.  If left untreated, the bacterial infection can destroy skin, tissue, and bone and can even spread throughout the body.

These non-healing wounds result from the inflammation and degeneration of peripheral nerves which can be a complication of diabetes. If the foot wound is not treated properly, hospitalization and possibly amputation could result by allowing anaerobic organisms to flourish. For patients with diabetes with accelerated atherosclerosis (hardening of the arteries), their resistance to infection is reduced and the lower extremity amputation rate is increased.

Most hyperbaric oxygen treatment is used as an adjunctive therapy in the management of diabetes complications, particularly diabetic foot ulcers that often result in amputation of toes, feet, or legs. Early, aggressive wound care strategies, combined with hyperbaric oxygen therapy treatment, can prevent osteomyelitis (inflammation of bone) and amputations and help improve the quality of life for patients with diabetes.

Referral Protocol:  Refer at 30 days when the diabetic wound has not shown significant progress with conventional treatment:

• Wound is classified as Wagner Grade III or higher (defined as penetrating deeper layers reaching tendon, bone or joint capsule with abscess, osteomyelitis or tendonitis extending to those structures)

• Patient has failed adequate course of standard wound therapy (30 days of assessment and correction of vascular abnormalities, optimization of nutritional status and glucose control, debridement, moist wound dressing, off-loading, and treatment of infection)

Hyperbaric oxygen therapy delivered at HyOx works to improve and heal the hypoxic areas through a significant increase in oxygen to the tissues. The elevation in oxygen tension in ischemic (restricted in blood supply) and infected wound tissue induces healing by enhancing fibroblast (a cell in connective tissue which produces collagen and other fibers) replication, collagen synthesis and the neovascularization (natural formation of new blood vessels) process. It works best as an adjunctive therapy to multi-disciplinary wound care.