Diabetic Foot
Diabetic foot is one of the most serious complications of diabetes mellitus and is the leading cause of non-traumatic lower-limb amputation worldwide.
It is a complex clinical syndrome resulting from the combined effects of three pathological mechanisms: peripheral neuropathy, vascular disease and the impaired immune response associated with diabetes.
It often begins with small wounds or ulcers on the foot, frequently over pressure points. Under normal circumstances, these would heal without difficulty, but in patients with diabetes they may develop into deep, chronic wounds that are difficult to treat.
Neuropathy reduces or eliminates the sensation of pain, allowing injuries to remain unnoticed for extended periods. Patients usually seek medical attention because of a visible wound, an unpleasant odor, swelling or, in advanced cases, tissue necrosis.
Characteristics
Diabetic foot is particularly difficult to manage because several pathological mechanisms act simultaneously.
Macroangiopathy restricts blood flow to the lower limbs, while microangiopathy compromises capillary circulation within the tissues.
The result is chronic local hypoxia. The tissues do not receive the oxygen required for healing, while white blood cells are unable to reach the affected area in sufficient numbers.
Microbial contamination further complicates the condition. Anaerobic microorganisms thrive in the hypoxic environment and may be difficult to eliminate with conventional treatment, particularly when the response to antibiotics is limited.
Without adequate treatment, the infection may spread to deeper tissues, including the tendons and bones, dramatically increasing the risk of amputation.
Scientific Recognition and Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy for diabetic foot is one of the most extensively documented applications in the field of hyperbaric medicine.
The Undersea and Hyperbaric Medical Society (UHMS) and the European Committee for Hyperbaric Medicine (ECHM) recognise it as an approved indication, based on a substantial body of clinical evidence.
Randomised clinical trials and meta-analyses have reported a significant reduction in amputation rates among patients with diabetes and chronic foot ulcers who received hyperbaric oxygen therapy as an adjunct to conventional treatment, compared with groups treated with standard care alone.
The scientific community consistently recognises the role of hyperbaric oxygen therapy as an important component of the multidisciplinary management of diabetic foot.
Hyperbaric Oxygen Therapy for Diabetic Foot
In diabetic foot, hyperbaric oxygen therapy does not replace conventional treatment, including regular wound debridement, antibiotics or blood glucose control.
It acts as a powerful adjunctive intervention that addresses the principal pathophysiological problem: insufficient oxygen within the affected tissue.
Breathing pure oxygen under increased pressure can raise the amount of oxygen dissolved in the plasma to levels up to 20 times higher than normal.
This allows oxygen to reach tissues with severely compromised capillary circulation, including the area surrounding the wound. Restoring oxygen delivery reactivates healing mechanisms, enhances white blood cell function, exerts a bactericidal effect against anaerobic pathogens and stimulates neovascularisation, contributing to a sustained improvement in blood supply.
A typical treatment course consists of 30 to 40 sessions. Wound progress is assessed regularly by the treating diabetologist or vascular surgeon in close collaboration with the hyperbaric medicine team.