Diabetic Foot Ulcers

Diabetic foot ulcer

BaroMedical - Diabetes preventive care
Unmanaged toe ulcer can lead to chronic wounds and gangrene
BaroMedical - Diabetes preventive care
Diabetic foot ulcers are the leading cause of lower limb amputations.

One of the most common and devastating complications of poor  circulation in diabetes is the foot ulcer.  About 25% of those ulcers do not respond to standard wound care, and are at risk of developing gangrene;  this leads to amputation in 85% cases (ref Can Diab Assoc).

Hyperbaric oxygen therapy provides sufficient oxygen for the damaged circulation to start budding new tiny blood vessels – capillaries.  The blood flow through those newly established capillaries is called microcirculation.  This process can take up to 20 days with daily oxygen therapy and can be tracked and assessed with Laser Doppler blood flowmetry (part of a micro-circulation assessment).  Improved microcirculation will speed up wound healing, reduce pain and prevent infection.

At BaroMedical we combine oxygen therapy with daily wound care using cutting edge products to reduce pain, odor, and infection, while promoting comfort and healing.

Diabetic clients who received oxygen therapy at BaroMedical for chronic wounds are reporting more stable blood sugar levels and  improvement with other complications associated with diabetes. The natural improvement in microcirculation with oxygen throughout the body and better blood sugar control reflects in: improved kidney and bladder function, better skin, gums, vision, memory, sexual drive, better intestinal function and blood pressure control and overall improved energy and better quality of life.

Warning signs

Symptoms of tingling, numbness, cramping and pain can quickly escalate to poor and prolonged healing of small cuts and nicks, larger chronic wounds, deeper gangrene and eventually amputation.

Diagnosis of poor circulation and oxygen supply is important and can be done with a micro-circulation assessment.

Prevention

Regular screening of circulation in your legs and feet (microvascular assessment) can identify deteriorating circulation before the onset of symptoms.  With timely preventive oxygen therapy, wound development and other complications associated with diabetes can be prevented. Diabetic clients who have received preventive oxygen therapy at BaroMedical are maintaining good health years after the diagnosis.

Cost / benefits analysis

Studies show that 70 to 90% of diabetes related amputations can be avoided with timely hyperbaric oxygen therapy (ref).  It has furthermore been documented to be cost effective therapy compared to traditional options (refref).

Human and hospital cost are devastating: 25% of all medicare cost goes to about 6% of population with diabetes (reference).

 

Hyperbaric oxygen (HBO) therapy for treatment of diabetic foot ulcers

  1. HBO increases oxygen transport to wound area stopping further tissue damage
  2. HBO facilitates growth of new capillaries (angiogenesis) promoting the microcirculation
  3. HBO speeds up wound healing by reducing inflammation and swelling
  4. HBO relieves pain
  5. HBO reduces infection by eliminating bacteria directly and increasing capacity of white blood cell to fight infection
  6. HBO improves microcirculation and elimination of toxins in the blood
  7. HBO enhances the effect of some antibiotics
  8. HBO stimulates release of stem cells from the bone marrow
  9. HBO decreases blood viscosity and risk of thrombosis and stroke
  10. HBO improves lymphatic circulation
  11. HBO improves bone density and mineralization and speeds up bone healing
  12. HBO enhances peripheral nerve regeneration for improved sensitivity
  13. HBO prepares tissue and bone for grafting before surgery
  14. HBO speeds up healing after surgery and improves chances of graft survival

Case file:  Diabetic foot ulcer –    PDF version

Diabetic foot ulcer before hyperbaric oxygen therapy

Male 55 years, diabetic for 25 years, insuline dependent for 13 years. Non smoker.
Right foot presenting 3 open ulcers and poor circulation with low tissue oxygen values. Loss of sensitivity in the whole foot and up to the knee. Wounds did not respond to wound care and antibiotis therapy and amputation of the  right foot was pending.   Left foot had partial amputation 3 month earlier.

Treatment protocol

Micro-circulation assessment on the left foot relieved pO2of 34 mm Hg which is 40% of normal tissue oxygen tension and 30 % of the normal blood flow.  Following the assessment, 9 hyperbaric session in oxygen compressed monoplace chamber were given on consecutive days and combined with daily wound dressing. Treatment pressure was above 2.2 ATA. Each session was 90 min long.

Treatment outcome

After 5 sessions the pain subsided and sensitivity returned in the right foot and up to the mid calf. After 9th session tissue oxygen tension in the left foot dorsum close to the toes increased to 51 mmHg. Also blood flow  measured with the Laser Doppler showed 32% increase from the pre-therapy value. Both values were   on  the lower end of the normal value and hyperbaric oxygen therapy was safely discontinued. The ulcer on the right heel (not visible on the picture) closed, and other two below the toes showed  new granulation. Client was advised to visit the podiatrist for debridement of the rough skin around the ulcer which can create another pressure point and receive proper off-loading shoe.  When reported for check up after three months all wounds were closed. See right picture below.

Initial evaluation:
diabetic foot ulcer before hyperbaric oxygen therapy
After 9 hyperbaric session over 2 weeks.
Diabetic foot ulcer after 9 hyperbaric oxygen sessions
Follow up at 3 months
diabetic foot ulcer before hyperbaric oxygen therapy

Diabetic foot ulcer after 9 hyperbaric oxygen sessions

Comments

Positive treatment result was obtained relatively quickly due to timely intervention.  Foot ulcers with infection and necrosis (gangrene) usually require more than 20 sessions to heal, but in this case therapy was discontinued as soon as the oxygen tension around the wound was high enough to prevent the area from reentering a state of hypoxia.  Oxygen tension was measured with transcutaneous oxymetry, and blood flow with Laser Doppler flowmetry.

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