Diabetic amputations annually in the U.S.
AHRQ Data Brief
80,000
Lifetime DFU risk in diabetic patients
Diabetes Care, 2023
19–34%
Higher odds of complete wound healing
HBOT vs. standard care alone
3.5×
Reduction in major amputation risk
Meta-analysis, 14 RCTs
40%
You've probably been told you're "doing everything right" — but the wound on your foot still won't close. Months of dressing changes, antibiotics, maybe surgery. And yet, every visit ends the same way: the wound looks about the same, or worse.
This isn't your fault. Diabetic foot ulcers are one of the most difficult wounds to heal because diabetes attacks healing from multiple directions at once. Nerve damage means you don't feel the injury forming. Blood vessel disease starves the tissue of oxygen. High blood sugar feeds bacteria and slows your immune response. The wound becomes trapped in a cycle it can't escape on its own.
And the stakes are brutally high. Foot ulcers precede 84% of diabetic amputations. Once a major amputation happens, the 5-year survival rate is worse than many cancers.
Understanding Diabetic Foot Ulcers
"The wound care team was doing everything they could. But after six months, my husband's ulcer was getting deeper, not better. His podiatrist said HBOT was the next step before we had to talk about amputation. Twelve weeks later, the wound was closed. He kept his foot."
— Family member of a DFU patient treated with HBOT
Hyperbaric Oxygen Therapy doesn't replace your wound care team — it supercharges what they're already doing. By breathing 100% oxygen in a pressurized chamber, we dramatically increase the oxygen dissolved in your blood plasma. That oxygen can now reach tissue where blood flow is compromised — exactly where diabetic wounds get stuck.
How HBOT Treats Diabetic Foot Ulcers
- Angiogenesis: Stimulates growth of new blood vessels into the wound bed
- Collagen synthesis: Enables fibroblasts to produce the structural matrix for tissue repair
- Leukocyte function: Restores white blood cell killing ability, impaired at low oxygen levels
- Antimicrobial effect: Creates an oxygen-rich environment hostile to anaerobic bacteria
- Edema reduction: Vasoconstriction decreases swelling while maintaining oxygen delivery
- Biofilm disruption: May enhance effectiveness of antibiotics against resistant wound infections
Mechanisms of Action
What happens inside the chamber:
At 2.0–2.5 times normal atmospheric pressure, oxygen becomes a powerful therapeutic agent. Tissue oxygen levels can increase 10- to 15-fold. This triggers a cascade of healing responses that standard wound care alone cannot achieve:
Additional requirements: Failed to respond to 30 days of standard wound care, OR post-surgical debridement of infected wound. Adequate arterial supply (TcPO₂ ≥ 30 mmHg on room air, or completed revascularization). No absolute contraindications to HBOT.
Extensive gangrene
Grade 5 ✓
Localized gangrene
Grade 4 ✓
Deep ulcer with abscess or osteomyelitis
Grade 3 ✓
Deep ulcer to tendon/capsule
Grade 2
Grade 1
Superficial ulcer
Pre-ulcerative / High-risk foot
Grade 0
Medicare and clinical guidelines support HBOT for diabetic foot ulcers meeting these criteria:
Patient Selection Criteria
Sources: Wound Repair Regen. 2024;32:e13133 · Sci Rep. 2021;11:2189 · Cureus. 2025;17(2):e40062 · UHM. 2015;42(3):205-247
Key Findings from Published Research
Clinical Evidence for Physicians
HBOT for diabetic foot ulcers carries the strongest evidence base of any hyperbaric indication. The Wound Healing Society, UHMS, and CMS recognize HBOT as a Level I, evidence-based adjunctive therapy.
What Treatment Looks Like
HBOT isn't a single treatment — it's a structured course of therapy designed to fundamentally change the healing environment in your wound. Here's what to expect:
HBOT works best when integrated with your existing care team. We communicate directly with your specialists and never operate in a silo.
Care Coordination
Primary Care
We provide progress summaries and flag any systemic concerns observed during treatment.
Infectious Disease
For osteomyelitis or complex infections, we align HBOT timing with antibiotic courses and surgical debridement.
Endocrinology
Glycemic control is foundational. We reinforce your diabetes management goals throughout treatment.
Vascular Surgery
If revascularization is needed, we coordinate timing. HBOT can begin post-procedure to protect reperfused tissue.
Podiatry
Offloading strategies, footwear modifications, and surgical planning remain under your podiatrist's direction.
Wound Care Team
We share weekly wound measurements and photos. Debridement schedules continue alongside HBOT.
No. Most patients find sessions relaxing. You may feel mild ear pressure during pressurization (similar to descending in an airplane), which resolves with simple techniques we'll teach you. The chamber is climate-controlled and comfortable, and you can watch TV or rest during treatment.
What if my wound has been present for years?
No. Most patients find sessions relaxing. You may feel mild ear pressure during pressurization (similar to descending in an airplane), which resolves with simple techniques we'll teach you. The chamber is climate-controlled and comfortable, and you can watch TV or rest during treatment.
Is HBOT painful?
Absolutely — in fact, we require it. HBOT is an adjunctive therapy, not a replacement for wound care. We work closely with your existing team and send weekly updates. Debridement, dressing changes, and offloading continue throughout your treatment course.
Can I keep seeing my wound care doctor during HBOT?
The Wagner classification grades diabetic foot ulcers from 0–5 based on wound depth and tissue involvement. Grade 3 indicates a deep ulcer with abscess formation, osteomyelitis (bone infection), or joint involvement. Grades 3–5 qualify for HBOT coverage because they carry significantly higher amputation risk.
What is Wagner Grade 3?
Yes. Medicare, Medicaid, and most private insurers cover HBOT for diabetic foot ulcers when specific criteria are met: Wagner Grade 3 or higher classification, failed response to 30 days of standard wound care, and adequate vascular supply. We verify your coverage before beginning treatment.
Is HBOT covered by insurance?
Typical treatment protocols involve 20–40 sessions, delivered 5–6 times weekly. Each session lasts 90–120 minutes. The exact number depends on wound severity, your healing response, and coordination with your wound care team. Many patients see measurable improvement within 2–3 weeks.
How many sessions will I need?
Yes. HBOT is FDA-approved and carries Level I evidence — the highest level of clinical proof. A 2021 meta-analysis of 14 clinical trials showed HBOT reduces major amputation risk by 40% and significantly improves complete wound healing rates compared to standard wound care alone. The Wound Healing Society recommends HBOT for Wagner Grade 3+ diabetic foot ulcers.
