Foot lesions in diabetics are potentially threatening and have multiple etiologies. It is important to identify patients at risk in order to prevent major complications: an amputation is preceded by an ulcer. Nowadays, knowledge of pathology and course of diabetic foot morbidity, together with development of therapies, offer opportunities for individualized management and optimal outcome for every “diabetic foot”.

Conclusively, use of HBOT is beneficial in almost all “diabetic foot” lesions, especially in the case of

  1. development of foot ulcer. Fast and sufficient wound healing is of paramount importance, and promotion of angiogenesis by HBOT offers lasting effect on tissue perfusion
  2. ischemic foot lesions
  3. soft tissue infection, with or without ulceration
  4. underlying osteomyelitis, combined with antibiotics
  5. Charcot arthropathy, in order to relieve symptoms, improve mobility and avoid complications

In addition to “diabetic foot” pathology, HBOT should be considered in general ill-health conditions where Diabetes coexistence is expected to greatly impede wound healing and/or predispose to complications, such as:

  1. fractures of the ankle and lower third of tibia. Here, vascularity is poor by default and there is excessive risk of insufficient bone healing and related complications (delayed union, non-union, pseudarthrosis, infection). HBOT should be recommended early, to avoid such complications. But when they appear, then HBOT is clearly indicated and should be initiated without further delay
  2. joint sprains, for fast mobilization and reduction of oedema that can lead to ischemic changes of the skin
  3. lower extremities orthopaedic surgery (eg arthroplasty). Surgical trauma combined with coexisting diabetic microvascular disease may predispose to ischemia, delayed wound healing or infection
  4. venous insufficiency chronic ulcers. Appropriate management combined with HBOT results in excellent healing rates
  5. erysipelas or other soft tissue infection of the lower extremities. May be resistant to antibiotic treatment. Personal experience of using HBOT in combination with antibiotics shows excellent results and practically no reoccurrence