Does hyperbaric oxygen help diabetic foot ulcers heal? Here our answer is yes, and it is the only topic in this series where we will say that without hedging the whole way through.
We have already said we would not sell you sessions for hair transplant scabs, and that facelift recovery is a careful maybe. This is the opposite case. The difference is not our opinion. It is the quality of the studies.
The evidence
Sharma and colleagues pooled 14 controlled clinical trials covering 768 participants in Scientific Reports in 2021. Twelve of the fourteen were randomised controlled trials.
- Complete wound healing: 148 of 321 patients with hyperbaric oxygen added to standard care, against 75 of 323 on standard care alone.
- Major amputation: 27 of 232 against 46 of 231. A relative risk of 0.60.
Look at what is being counted there. Not a satisfaction score. Not a photograph somebody judged by eye. Healed or not healed, and limb kept or limb lost. Those are hard endpoints, measured across hundreds of patients in randomised trials, and that is a different order of evidence from a five-person case report.
Now the parts nobody quotes
Since we have spent other articles pulling apart weak evidence, it would be dishonest to skip the awkward findings in this one.
Minor amputations showed no significant benefit. The reduction was in major amputations. Toes were not saved at a rate you could call reliable.
Adverse events were more common in the hyperbaric groups, not less. That is in the same paper, and it belongs in the same sentence as the benefit. Hyperbaric oxygen is a medical treatment with side effects, most commonly ear barotrauma, and it is not risk-free just because it is only air under pressure.
The authors flag methodological problems across the included trials and say their findings should be generalised cautiously. Individual large trials in this field have also come out negative. So the picture is genuinely positive, but it is not unanimous, and anybody telling you it is settled has not read it.
Why it should work here, of all places
A diabetic foot is the textbook case of an oxygen problem. Circulation is already reduced, so less blood reaches the tissue. Nerve damage means injuries go unnoticed and stay untreated. Infection, when it arrives, consumes oxygen and thrives where there is little of it.
Under pressure, breathing high concentrations of oxygen, a large amount dissolves directly into blood plasma rather than travelling bound to red blood cells. Plasma can reach tissue that red cells struggle to serve. That supports the fibroblasts laying down collagen, the signalling that builds new capillaries, and the oxygen-dependent mechanism white blood cells use to kill bacteria.
In other words, this is the situation the whole idea was designed for. Where oxygen delivery is what is holding healing back, adding oxygen has something to do. That is also why it does far less in situations where oxygen was never the problem.
Adjunct means adjunct
In every one of those trials, hyperbaric oxygen was added to standard wound care. It never replaced it. The heavy lifting in a diabetic foot ulcer is done by debridement, offloading pressure with the right footwear or a cast, controlling infection, and managing blood sugar. If those are not happening properly, no chamber will rescue the situation.
Our longer explainer on hyperbaric oxygen therapy for diabetic foot ulcers covers the standard care pathway in more detail.
Be honest with yourself about the commitment
The protocols in these trials ran at 2.0 to 2.4 ATA, for 90 to 120 minutes, for 20 to 30 sessions, typically five days a week. That is four to six weeks of turning up almost daily. It is a serious commitment of time and money, and it is worth knowing that before you start rather than after session eight.
Start with the NHS, not with us
If you have a diabetic foot ulcer, your first call is your GP or your NHS diabetic foot service, not a private clinic. They will assess the wound, arrange the debridement and offloading, and manage the infection risk. Hyperbaric oxygen is something to consider alongside that pathway, on the advice of the people managing your care.
Medical oxygen is a prescription-only medicine in the UK. If your healthcare team thinks hyperbaric oxygen is appropriate for you, come and talk to us and we will assess you individually before anything is booked.
The rest of this series
So far: hair transplant scabs (no) and facelift recovery (a careful maybe). Next week, surgical infection, where the answer is yes but you should be in a hospital rather than in our clinic.
Reference
- Sharma R, Sharma SK, Mudgal SK, Jelly P, Thakur K. Efficacy of hyperbaric oxygen therapy for diabetic foot ulcer, a systematic review and meta-analysis of controlled clinical trials. Scientific Reports. 2021;11:2189. Read the meta-analysis
General information about published research, not medical advice. If you have a diabetic foot ulcer, seek medical assessment promptly.