Hyperbaric Oxygen for Foot Wounds: Who Really Benefits

When a foot wound has been open for months, people often ask us about “the oxygen chamber.” Hyperbaric oxygen helps some people, and the research gives a reasonably clear picture of who benefits from hyperbaric oxygen and who doesn’t. But it helps no one until the reasons the wound stalled have been dealt with, and those reasons are often fixed with a procedure. This article is about choosing the right patient. For how a course of treatment runs day to day, see our page on hyperbaric oxygen therapy. When it fits, we refer you to a hyperbaric center and keep treating the wound alongside it.

First, find out why the wound stalled

Hyperbaric oxygen means breathing pure oxygen in a chamber pressurized to at least twice normal air pressure, which raises the oxygen level in tissue that is short of it.⁠^[1] That sounds as if it should help any slow wound. But the international practical guideline is clear that even careful local wound care can’t make up for untreated infection, poor blood flow or ongoing pressure on the wound,⁠^[5] and extra oxygen doesn’t remove those causes either.

The international guideline’s hyperbaric oxygen recommendation applies only when standard care alone hasn’t healed the ulcer,⁠^[1] and several parts of that care are surgical jobs. Debridement clears the wound bed; Dr. Efe Ozturk drains deeper infection and removes infected bone; and tendon or bone procedures take pressure off an ulcer that keeps reopening (see surgery that takes pressure off ulcers).

Blood flow gets its own check. When an ulcer comes with signs of poor circulation, the vascular guideline advises considering a procedure to restore flow and consulting a vascular specialist.⁠^[6] We do noninvasive circulation testing at our practice and refer you when an artery needs opening; see restoring blood flow.

What the trials found

Six of the main studies are summarized below. Two double-blind trials point in opposite directions, and the reviews help explain why.⁠^{[2,3,7,8,9,4]}

Pooling eight randomized trials that each lasted at least 12 weeks, a 2025 analysis found more ulcers healed and fewer major amputations with hyperbaric oxygen, although serious adverse events were reported more often.⁠^[10] The international guideline panel reads the evidence as conflicting: the trials at lowest risk of bias suggest some benefit for healing, but good evidence that it prevents amputation is lacking, and overall certainty is low.⁠^[1]

Who is most likely to benefit

The pattern across these studies points to a fairly specific person.

• A diabetic foot ulcer with reduced blood flow. The guideline suggests considering hyperbaric oxygen for ischemic or neuro-ischemic ulcers when standard care alone has failed and a hyperbaric unit already exists, while noting that the groups most likely to benefit still need study.⁠^[1] The global vascular guidelines see a possible role for nerve-related ulcers with mild ischemia that haven’t responded to conventional wound care.⁠^[11]
• A wound that has stalled despite good care. The practical guideline lists it among add-on options for non-infected ischemic ulcers that haven’t healed after 4–6 weeks of optimal care.⁠^[5]
• Enough oxygen reaching the skin to respond. In a follow-up analysis of the Swedish trial, among people given oxygen who completed the course, no ulcer healed when the oxygen level measured through the skin on top of the foot (TcPO2) was below about 25 mm Hg, while 73% healed at 51–75 mm Hg.⁠^[12] Ankle and toe pressures did not predict the result.⁠^[12] Toe pressure still helps judge a wound’s overall chance of healing,⁠^[6] which is why it is worth understanding when ankle pressures mislead. See circulation tests for foot wounds.
• Blood flow already restored, or not restorable. The Swedish trial enrolled people with adequate blood flow to the foot or artery disease that couldn’t be repaired; in the trial from the Netherlands and Belgium, revascularization, when possible, generally came before the oxygen.⁠^[11]
• Someone able to finish the course. In that second trial, 35% of those assigned to oxygen couldn’t complete it as planned; those who did had significantly fewer major amputations.⁠^[7] The guideline notes that frailty and other illness can rule it out, and that it suits people who live near a unit and can commit to weeks of treatment.⁠^[1]

Who is unlikely to benefit

• Ulcers with good circulation. The review of these ulcers found no benefit and concluded that routine use can’t be recommended.⁠^[4] In the large observational study of well-perfused ulcers, the authors used statistical methods to account for who was chosen for treatment and still found no improvement in healing or amputation.⁠^[8]
• Severe blockage that hasn’t been treated. The global vascular guidelines advise against offering hyperbaric oxygen to save a limb when severe ischemia hasn’t been corrected, and say it should not replace revascularization.⁠^[11] See peripheral artery disease.
• Infection on its own. The infection guideline suggests not using hyperbaric oxygen for the sole purpose of treating a foot infection.⁠^[13] Infection is cleared with antibiotics and, when needed, surgery to drain it.

Where surgery fits

For many stalled ulcers, the step that changes the course is a procedure that removes the cause: clearing dead tissue, draining infection, taking out infected bone, correcting the deformity that loads the ulcer, or, when part of the foot can’t heal, removing only that part. For an ulcer under the ball of the foot that non-surgical offloading hasn’t healed, the practical guideline suggests considering Achilles tendon lengthening or surgery on the metatarsal bone beneath it, together with an offloading device;⁠^[5] see Achilles lengthening for forefoot ulcers. Dr. Ozturk, a Foot and Ankle Surgeon who is board certified in wound care (FAPWH), performs these operations; see limb salvage surgery. For the wounds that need them, he also uses skin substitutes, wound VAC therapy and skin grafts, which have their own evidence; see what the skin substitute trials show.

Hyperbaric oxygen runs alongside that work, never instead of it: the guideline suggests considering it only as an add-on to standard care.⁠^[1] Your wound care visits continue throughout, and we measure the wound at each one to see whether it is responding.

The trade-offs

A review of its side effects calls hyperbaric oxygen among the safest therapies in use today, but it asks a lot of your time.⁠^[14] In the two double-blind trials, a course meant 30 or 40 sessions of about 90 minutes; in the Swedish trial they ran five days a week for eight weeks.⁠^[3,2]

• Ear pressure is among the most common side effects; coaching during pressurization helps prevent it.⁠^[14]
• Distance vision often blurs after several weeks and usually returns to normal within 3–6 weeks of finishing.⁠^[14]
• Blood sugar can drop during treatment, so centers set a minimum level before each session.⁠^[14]
• Seizures from oxygen are uncommon, about 1 in 2,000–3,000 treatments, and resolve without lasting damage once the oxygen level is lowered.⁠^[14]

The larger limit is the evidence itself: the guideline rates its certainty as low.⁠^[1]

Questions to ask

• Has the blood flow to my foot been measured, and can it be improved?
• Have infection, dead tissue and pressure on the wound been dealt with?
• Has my wound stalled despite four to six weeks of good care?
• Can I get to a hyperbaric center most weekdays for about two months?
• If amputation has been raised, should I get a limb salvage second opinion?

Common questions

Does hyperbaric oxygen help a wound heal?

Sometimes. The trials with the lowest risk of bias suggest some benefit for healing, but the evidence conflicts, and in ulcers with good blood flow no benefit has been shown.⁠^[1,4]

Can it prevent an amputation?

Pooled studies of ulcers with artery disease found fewer major amputations,⁠^[9] but the guideline panel judged good evidence of amputation prevention to be lacking.⁠^[1] Restoring blood flow and surgery that removes infection come first.

Will my insurance cover it?

Coverage depends on your plan, and some plans need prior authorization. Please call our office at 908-215-5953 to inquire about your insurance.

Does it treat a bone infection?

There is little evidence that it clears soft-tissue or bone infection, and the infection guideline suggests not using it just to treat a diabetic foot infection.⁠^[13] Removing infected bone can be the step that helps; see does osteomyelitis mean amputation?

Is topical oxygen the same thing?

No. Topical oxygen is delivered to the wound by a device, can be used at home, and has its own conditional, low-certainty recommendation.⁠^[1]

The bottom line

Hyperbaric oxygen can help a specific group: people with a diabetic foot ulcer, some loss of blood flow that has been treated or can’t be, and a wound that hasn’t improved after weeks of thorough care. For most other wounds, the evidence doesn’t support it. Whatever the plan, clearing infection, removing dead tissue, taking pressure off and restoring blood flow come first, and surgery is often how that happens. Early care matters too; see why early wound care matters.