Diabetic ulcers that fail to heal in three months are usually considered chronic. Some take years to heal or never do.

Wound care specialists classify diabetic foot ulcers using the Wagner Grade Scale:

  • Grade 0: no open lesions, but may possess preulcerative lesions, healed ulcers, presence of bone deformity
  • Grade 1: superficial ulcer, not involving subcutaneous tissue
  • Grade 2: deep ulcer with penetration through the subcutaneous tissue, potentially exposing bone, tendon, ligament, or joint capsule
  • Grade 3: deep ulcer with bone inflammation, abscess ,or bone infection
  • Grade 4: gangrene of a toe
  • Grade 5: gangrene of foot requiring amputation

Diabetic ulcers require a healthy, oxygenated wound bed to heal. A lack of sufficient oxygen (hypoxia) in the wound bed slows or stops the normal healing process. Wound healing in people with diabetes is often complicated by poor blood circulation in the feet and legs. Nerve disease (neuropathy) may also cause a loss of sensation in the feet and legs, so even a small cut, sore, or pressure ulcer may go unnoticed for some time and develop into a problem wound.

Diabetic ulcers are especially prone to serious bacterial infections that threaten life and amputation.

Hyperbaric oxygen therapy (HBOT) is an effective addition to traditional wound care therapies.

HBOT helps repair wounds and enhance healing by improving blood circulation, encouraging the formation of new capillary blood vessels (angiogenesis), supplying more oxygen to tissue in the wound bed, and stimulating the growth and distribution of stem cells. Hyperbaric oxygen also helps kill the anaerobic bacteria that cause some of the worst infections in chronic wounds. Evidence for HBOT is especially strong in diabetic foot ulcers classified Wagner Grade 3 or higher, for which hyperbaric oxygen is widely considered standard therapy and prevents the need for amputation.