Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers: Comparison With Standard Care and Current Clinical Evidence

Background: Diabetic foot ulcers are a common and serious complication of diabetes, associated with high morbidity, higher healthcare costs, and an increased risk of lower limb amputation. Despite advances in standard wound care, a significant proportion of diabetic foot ulcers remain resistant to treatment, prompting interest in adjunctive therapies such as hyperbaric oxygen therapy. Aim: The aim of this narrative review was to summarize and critically evaluate current evidence comparing HBOT with standard treatment modalities in patients with DFUs. Material and methods: A structured literature search was conducted using PubMed and Google Scholar to identify randomized controlled trials, systematic reviews, meta-analyses, and clinical guidelines related to the treatment of diabetic foot ulcers and hyperbaric oxygen therapy. Relevant publications were analyzed and synthesized narratively, focusing on wound healing outcomes, amputation rates, and safety considerations. Results: Evidence from RCTs suggests that HBOT may improve ulcer healing rates in patients with chronic, non-healing DFUs when used as an adjunct to standard care. Several meta-analyses indicate that HBOT is associated with increased rates of complete ulcer healing and a reduced risk of major amputations. However, findings from Cochrane reviews demonstrate that these benefits may be limited primarily to short-term outcomes, with inconsistent evidence regarding sustained long-term efficacy. HBOT was generally well tolerated, with adverse events being infrequent and mostly mild. Conclusions: Current evidence suggests that HBOT may be beneficial as an adjunctive treatment in carefully selected patients with refractory DFUs. Nevertheless, heterogeneity among studies and methodological limitations preclude definitive conclusions regarding long-term outcomes. Further high-quality, standardized randomized trials are required to clarify the role of HBOT in routine clinical practice.