Hyperbaric oxygen therapy (HBOT) is a treatment option that involves a person breathing almost pure oxygen in a special room or small chamber. Evidence suggests that HBOT may have a variety of applications, including the promotion of wound healing. Due to this, it may help treat diabetic foot ulcers.

Diabetes is a condition that affects how the body processes blood glucose. If blood sugar levels are not under control, this can increase the risk of complications. Potential complications include problems with the feet due to the effects of diabetes on blood circulation, which can slow wound healing.

Researchers estimate that 15–25% of people living with diabetes will experience a foot ulcer in their lifetime. Of these individuals, about 6% will require hospitalization due to complications.

In some cases, a doctor may consider suggesting HBOT. This treatment uses a special chamber in which a person breathes in oxygen at higher air pressure levels than average to help fill the blood with enough oxygen to aid with repairing tissue. Although research is still ongoing, growing evidence indicates that HBOT may be beneficial for treating diabetic foot ulcers.

In this article, we explore what HBOT is and how it can help promote wound healing in people with diabetic foot ulcers.

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Medical experts define HBOT as a treatment that involves an individual breathing near 100% oxygen in a hyperbaric chamber that is pressurized to greater than sea level pressure. The term hyperbaric refers to a gas being at a greater atmospheric pressure than usual.

The body requires oxygen to function correctly. The air that people breathe typically contains 21% oxygen. HBOT involves breathing almost pure oxygen in a special room to help the lungs collect more of this gas. This treatment aims to increase blood oxygen to help repair tissues and restore normal functioning of the body. This extra oxygen can help reduce inflammation, eliminate infections, and promote wound healing.

During HBOT, a person enters a special room known as a hyperbaric chamber. Manufacturers specially design this chamber to contain air at approximately 1.5 to 3 times higher pressure than the air in the atmosphere at sea level. Some chambers fit a single person, whereas others can accommodate several people at once.

Some of the more common conditions that HBOT can treat include:

  • adverse effects of radiation therapy
  • carbon monoxide poisoning
  • severe bacterial infections
  • decompression illness among divers
  • wounds that are slow to heal, such as diabetic foot ulcers

Individuals with slow-healing wounds can enter the hyperbaric chamber for up to 2 hours at a time. They may require 20–60 HBOT sessions.

The Food and Drug Administration (FDA) has given HBOT approval for the treatment of 13 conditions, including wounds such as diabetic foot ulcers. The Undersea & Hyperbaric Medical Society also lists HBOT as a treatment option for diabetic foot ulcers.

A 2018 study reported that HBOT was effective in treating 74.2% of diabetic foot ulcer cases. The use of HBOT dramatically improved the foot ulcer healing process compared with other treatment methods.

However, it is worth noting that doctors may not suggest HBOT until they classify the wound as a Wagner grade 3 or higher. This grading system uses a scale of 0–5 to indicate the extent of tissue damage and involvement.

During the natural wound healing process, the body uses oxygen to stimulate the healing and growth of new tissue. HBOT helps encourage the formation of new blood vessels around the wound area, and these supply the area with more oxygen. This influx of oxygen and other healing nutrients helps generate new, healthy tissue.

However, the authors of a 2020 systematic review and meta-analysis note that while HBOT lowers amputation rate, it may not improve wound healing and may vary in effectiveness. They add that HBOT may be effective in addition to other treatments for diabetic foot ulcers, though.

A 2021 systematic review and meta-analysis concludes that although more research is still necessary, HBOT may provide an effective treatment option for severe diabetic foot ulcers. As such, doctors will likely only recommend this treatment for foot ulcers with a classification of Wagner grade 3 or higher. Individuals who are interested in HBOT can speak with a doctor to learn more about this treatment.

HBOT may provide several benefits for individuals dealing with diabetic foot ulcers. The primary benefit is that it can speed up the healing process. A quicker recovery time can help individuals living with diabetes regain the benefits of an active lifestyle and avoid complications that relate to foot ulcers.

A 2020 systematic review and meta-analysis adds that in addition to promoting healing, this treatment can help reduce serious adverse events, such as amputation and wound infection, as well as improving the quality of life.

Learn more about how diabetes may affect the feet.

As with any medical procedure, HBOT carries certain risks. Some possible side effects associated with HBOT include:

  • damage to the sinuses and ears
  • changes in vision, such as nearsightedness
  • lung damage
  • oxygen poisoning, which can result in seizures

Some people may experience other complications, such as hypoglycemia during hyperbaric treatments. To avoid this, it is advisable to eat before treatments and to monitor blood glucose regularly during the appointment.

Individuals with claustrophobia may find that being within a hyperbaric chamber triggers their symptoms. Although manufacturers try to design these chambers for maximum comfort, people who do not feel comfortable in small spaces should work with a doctor to prepare for an HBOT session.

However, most side effects are generally mild, and people can typically avoid them if the treatment does not last more than 2 hours and the pressure in the chamber is less than three times that of normal pressure.

It is essential to receive HBOT only from board certified and trained medical staff to minimize the risk of complications.

Although healing diabetic foot ulcers is likely the most well-known benefit of HBOT in diabetes, this treatment may also help with other diabetes symptoms, such as:

Blood sugar levels

Some people with diabetes may find it difficult to maintain healthy blood sugar levels. Extremely high or low blood sugar can have serious health consequences.

A 2015 study notes that for individuals living with type 2 diabetes, regular HBOT sessions may help improve glucose tolerance and blood sugar levels. The reason for this is that HBOT can cause people’s blood sugar to drop.


Another potential complication of diabetes is diabetic retinopathy. This refers to damage to blood vessels in the eye that can result in vision problems.

A 2020 study suggests that HBOT can help prevent diabetic retinopathy or slow its progression. Although more research investigating its potential benefits is necessary, HBOT may offer another treatment option to help manage eye health in those living with diabetes.

An untreated diabetic foot ulcer can cause severe damage to the foot, which may require amputation. However, the condition is preventable, and timely treatment can help minimize the risk of permanent damage.

Typically, prevention and treatment options include:

  • controlling blood glucose and attending regular checkups with a diabetes healthcare team
  • exercising regularly and eating a nutritious, well-balanced diet
  • stopping smoking
  • undergoing debridement, which involves cleaning the wound and removing dead tissue
  • taking antibiotics to help treat infections
  • relieving pressure from the ulcerated areas using appropriate footwear, braces, crutches, or a wheelchair
  • using other treatments to promote wound healing, such as saline, growth factors, ulcer dressings, and skin substitutes

A diabetic foot ulcer is a potential complication of diabetes. It occurs when irregular blood sugar levels affect blood circulation in the feet, which can slow wound healing. In addition to controlling blood glucose, a doctor may suggest HBOT to help treat severe diabetic foot ulcers.

The FDA approves the use of HBOT to treat nonhealing wounds, such as diabetic foot ulcers. The procedure involves a person entering a pressurized room and breathing almost pure oxygen. This increases the amount of oxygen in the blood, boosting the oxygen flow to the wound, which promotes healing.

Although more research is still necessary, growing evidence suggests that HBOT is effective in treating diabetic foot ulcers.