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The patient may have been a diabetic, but she was also a great-grandmother who dreamed of going on a cruise with her family. One problem stood in her way and she was standing on it – a non-healing foot wound that hampered her mobility. After outpatient therapy at Florida Hospital Fish Memorial's Wound Care and Hyperbaric Center, she recovered and was well enough to travel.

Diabetes and Foot Ulcers

Diabetics are at high risk for developing non-healing foot wounds known as foot ulcers, which, left untreated, can require lower limb amputation. Of approximately 17.9 million diabetics in the United States, 60 to 70 percent have some degree of diabetic neuropathy or nerve damage.* "It's not uncommon for diabetics to have wounds on the bottom of their feet and not even know it," says Center Director Renee McCullough, adding, "Many diabetics have had the disease long enough to compromise their blood circulation. Over long periods, elevated blood sugar levels damage blood vessels. This makes it harder for oxygen to reach the cells of the skin. The feet, being the furthest out and bearing the most pressure from gravity, are often the most common site of wounds in people with diabetes." According to McCullough, approximately 35 percent of the patients at the Wound Care and Hyperbaric Center are diabetics.

Causes and Concerns

In addition to diabetic neuropathy, other factors can create foot ulcers. Peripheral vascular disease and obesity are considered risks. Combine any of these conditions with foot trauma, and diabetics have a higher probability of ulcers. What begins as a minor foot injury can have major implications. "Lower extremity ulcers and subsequent lower extremity amputations occur mostly among patients with diabetes mellitus. Better control of diabetes, appropriate foot care and proper wound management when ulcers occur would reduce the rate of disabling amputations," comments Godson Oguchi, M.D. Affiliated with Florida Hospital Fish Memorial, Dr. Oguchi specializes in infectious diseases and is the Center's Medical Director.

Prevention and Protection

With diligence, diabetics can decrease the occurrence of ulcers. Maintaining appropriate glycemic levels and weight is a good start, followed by proper footwear. McCullough cautions against wearing sandals or ill-fitting shoes. Sandals make the feet susceptible to trauma. Poor fitting shoes cut off circulation and create friction that leads to foot ulcers. Daily foot inspections are also vital. "We provide patients with pocket-size mirrors to check the bottom of their feet," McCullough says.

Treatment Options

Screening is the first step in treating non-healing wounds. "Diagnostics help us understand the wound etiology," McCullough explains. A transcutaneous oxygen measurement, for example, measures oxygen levels at the wound edges. "If wounds aren't well-oxygenated, they won't heal," says McCullough.

The Center uses different modalities to treat wounds, including debridement, specialty dressings, radiology, nuclear medicine and bioengineered skin grafts. "The nice thing about our hospital affiliation is our huge inventory of dressings and treatments. It would be difficult for any single physician to stock the variety of products we have available," McCullough notes.

Hyperbaric Oxygen Therapy

In the near future, the Center will boost its treatment options with the addition of two Hyperbaric Oxygen Therapy (HBOT) chambers. In this innovative procedure, patients breathe 100 percent oxygen while reclining in a chamber pressurized to two to three times atmospheric pressure. They can watch television, or use relaxation techniques taught by the Center's staff. Hyperbaric therapy delivers high concentrations of oxygen to the bloodstream and wound bed. When the bloodstream is hypersaturated with oxygen, tissues attain oxygenation levels that are otherwise impossible. This process promotes blood vessel growth, drives healthy blood to the wound and accelerates healing. HBOT is considered a superior therapy because it encourages faster, more complete healing.

"There is a great deal of research to support the effectiveness of hyperbaric medicine in the treatment of diabetic foot ulcers. Medicare considers hyperbaric medicine an appropriate therapy for non-healing diabetic foot ulcers and does reimburse for it," McCullough explains. Used in conjunction with standard wound care dressings and debridement, hyperbaric therapy has produced promising results. Some studies have demonstrated that patients who underwent HBOT had about one fourth the risk of amputation compared to patients who underwent traditional therapy alone. Whether traveling around the world or around town, diabetics can often regain healthy foot function with proper treatment. Working with physicians, the Wound Care and Hyperbaric Center can determine whether hyperbaric therapy is appropriate for patients with non-healing wounds.


*American Diabetes Association and "Neuropathy in Diabetes. Diabetes in America. 2nd ed."

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