Published December 12, 2024
When it comes to foot care, patients with diabetes must keep a keen eye on their feet. At Bridgeport Hospital, some patients may also find hyperbaric oxygen therapy (HBOT) to be an additional effective therapeutic option for treating nonhealing, chronic wounds, such as diabetic foot ulcers.
HBOT is a medical treatment in which patients breathe 100 percent pure oxygen inside a compression chamber. (By comparison, the air we inhale contains about 20 percent oxygen.) When pure oxygen is inhaled at an increased pressure, it increases the effects of some antibiotics, activates white blood cells to fight certain infections and promotes the healing process of chronic wounds that have failed to heal or tend to recur.
“In some patients, HBOT has been shown to be an effective, concurrent therapy for many difficult-to-heal wounds,” said Ceasar Irby, DPM, who is section chief of podiatry at Bridgeport Hospital and affiliated with Northeast Medical Group. “It’s done in concert with good wound care.”
Bridgeport Hospital offers HBOT for a range of wounds at its Center for Wound Healing and Hyperbaric Medicine, with pressurized hyperbaric chambers at both its Bridgeport and Milford campuses. Dr. Irby serves on the HBOT team, working with physicians and other specialists to assess patients and devise treatment plans for those who might benefit from the therapy.
HBOT is used to treat minor, complex or chronic wounds resulting from a range of conditions, such as lymphedema, minor burns, vascular leg wounds, head and neck injuries, tooth extractions and more. HBOT increases oxygenation to the surrounding tissue to heal cells and promote blood vessel growth.
It also enables Yale New Haven Health Heart and Vascular Center specialists to manage patients at high risk of limb loss by diagnosing and facilitating timely treatment for non-healing wounds that have been unresponsive to initial therapy or persist despite continued care. This includes non-healing lower extremity wounds, such as patients with critical limb ischemia, peripheral arterial disease and diabetic foot and ankle complications.
For a patient with diabetes, small cuts and scrapes can become a serious problem if undetected. “One of the complications of diabetes is diabetic ulceration, which usually happens after one has diabetic neuropathy, the loss of sensation to the foot as well as poor circulation,” Dr. Irby said.
“Once patients with diabetes have an ulceration on one foot, there is a greater than 50 percent chance that they will experience another ulcer on that foot at some time in their life, even with treatment,” he said.
“One of the things that happens to people who have either uncontrolled diabetes or long-term diabetes is that the excess sugar in the bloodstream can affect their eyes, kidneys and nerves,” Dr. Irby explained. “So, when a patient loses sensation in the foot, what will happen over time is that a patient could step on something – a needle, a tack, a nail – and they wouldn’t even notice because they don’t have sensation.
“Patients with diabetes don’t feel pain the same way and their body doesn’t fight infection the same way, which is a problem when you step on something.” Dr. Irby said. “And that usually leads to an infected wound that could lead to an advanced infection in the bone, increasing the risk for amputation.”
Prevention remains the first line of defense. “If you are a patient with diabetes who is not at high risk, the recommendation is for you to have a yearly foot exam, where we check to make sure your sensation is the same, you have good circulation and you don’t have any open wounds,” Dr. Irby said.
For patients who are at higher risk, that visit is moved up to every three months to reduce the risk of amputation of a toe or a portion of the foot.
“We always recommend that patients call if they notice any difference in their feet. If they have an infection, we would promptly start them on antibiotics, get their sugars under control and make sure their wound is off-loaded by having them wear a special shoe that helps take the pressure off the area,” Dr. Irby said. “We try to be proactive on the prevention side and in the early stages of catching whatever the problem may be.
“When indicated, I recommend patients for the hyperbaric oxygen treatment,” Dr. Irby said. “Patients who have osteomyelitis or infections of the bone, or patients who have a compromised circulation – those are probably the two types of patients we recommend most.
“It’s a therapy, so it’s not to be done alone; it’s done with good wound care and good orthotic stewardship,” Dr. Irby said. “We are committed to giving patients the individualized care they need to help them resume activities of daily living and achieve the best quality of life possible.”
Learn more about hyperbaric medicine at Bridgeport Hospital.
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