Hyperbaric oxygen therapy for diabetic foot ulcers in Jordan
علاج تقرحات قدم السكري بالأكسجين المضغوط
Hyperbaric oxygen therapy for a diabetic foot ulcer means adding sessions of breathing high-concentration oxygen inside a pressurised chamber to an existing foot-care plan, in order to raise the oxygen reaching an ulcer that standard care has failed to close. This is a medically accepted use, but it is accepted on two conditions: the ulcer must be deep or advanced and unhealed despite correct treatment, and everything that should come before it must actually have been done. In practice that means hyperbaric oxygen is neither the first step nor a stand-alone one. Before and during it the ulcer needs surgical removal of dead tissue, control of infection with culture-directed antibiotics where infection exists, offloading of pressure from the ulcer site using a device, therapeutic footwear or crutches, blood-sugar control, and above all an assessment of the leg arteries. If there is a treatable arterial blockage, revascularisation by angioplasty or surgery comes first and is not replaced by chamber sessions. The limits are explicit. Hyperbaric oxygen does not treat diabetes, does not open a blocked artery, does not restore sensation lost to nerve damage, does not remove the need for surgery when dead tissue or bone infection is present, and does not cancel the need to offload the foot. It is also not a guarantee against amputation; it is prescribed as an adjunct to improve the chance of healing in selected cases, and each decision rests on clinical and vascular assessment rather than on patient request. This is a course of repeated sessions over weeks, not one or two visits, and its value is judged by measuring the ulcer objectively at intervals: is the area and depth shrinking and is the wound bed improving. If no objective improvement appears, the plan is reconsidered rather than simply continued. Some patients cannot enter a chamber. Untreated pneumothorax is an absolute barrier, active sinus or ear infection postpones the session, certain chemotherapy drugs conflict with it, uncontrolled epilepsy must be controlled first, pregnancy is excluded except in carbon monoxide poisoning, and claustrophobia needs preparation beforehand.
Procedure steps
- 1
Assessing the ulcer and the arteries first
The ulcer's depth, margins, dead tissue, discharge and any exposed bone are examined, and its area is measured to serve as a baseline for later comparison. Leg blood flow is assessed with pulses, Doppler and pressure measurements, because a treatable arterial blockage is dealt with first. Blood sugar, nutrition and foot sensation are also reviewed. Eligibility for sessions is set by this assessment, not by patient request.
- 2
Delivering the core ulcer treatment
Before sessions begin, dead tissue is removed surgically, any infection is treated with culture-directed antibiotics, offloading of the ulcer site is arranged with a device, therapeutic footwear or crutches, and dressings and blood sugar are brought under control. This step is not a formality: hyperbaric oxygen does not substitute for it, and without it the sessions cannot be expected to deliver worthwhile benefit.
- 3
Chamber preparation and ear equalisation
Your ears, sinuses and lungs are examined and all medications reviewed, and you are shown in practice how to equalise ear pressure by swallowing or moving the jaw, since the ear is the commonest site of trouble inside a chamber. Fire-safety rules then apply: designated clothing, no oil-based product, greasy ointment or perfume, and no lighters, phones or any electronic device inside the chamber.
- 4
The session itself
Pressure is raised gradually while you equalise your ears, you then breathe oxygen for a set period while lying or sitting, with air breaks as scheduled, and pressure is finally lowered gradually. The technician stays in contact and asks about your ears and breathing. **Severe ear pain that does not clear with equalisation, or bleeding from the ear, stops the session**, and pressure is never pushed on a patient in pain.
- 5
Measuring response and deciding to continue
Sessions continue on a weekly schedule and the ulcer is measured at intervals: area, depth, the tissue in its bed, and new tissue advancing from the edges. If it is objectively shrinking, the course continues; if nothing has changed after a reasonable period, the diagnosis, perfusion, infection and the decision to continue are all reviewed, rather than extending the course indefinitely in hope.
Before the procedure
Tell the doctor how long the ulcer has been present and everything already tried for it, including dressings, antibiotics and operations, and share your blood-sugar readings and HbA1c if available. Report all medications, especially chemotherapy, and any epilepsy or seizures, chronic lung disease, previous collapsed lung or ear surgery. Contact the centre to postpone the session if you develop a cold, blocked nose, or an ear or sinus infection, because a blocked ear is the most painful problem inside a chamber. Learn and practise ear equalisation before you go in. Bring your offloading device or therapeutic footwear and use it exactly as prescribed; do not walk on the ulcer because you are having sessions. Eat a light meal rather than arriving fasting, check your blood sugar before entry and tell the technician the value. Do not smoke. Wear no oil, greasy ointment, rich cream, perfume or deodorant, and bring no lighter, phone or smart watch into the chamber, as this is a fire-safety rule. If closed spaces frighten you, say so in advance so the chamber can be explained and anxiety eased.
After the procedure
Keep doing everything prescribed for your foot after the session: the dressing exactly as taught, any antibiotic course to completion, offloading the ulcer with every step you take, and blood-sugar control. Check your sugar afterwards, as it can fall in some patients following hyperbaric oxygen. Inspect both feet daily with a mirror or with help, looking for any new break in the skin or change in colour. Do not drive while dizzy or while vision is blurred, and if your vision shifts as the course progresses, that change is usually temporary and reverses after sessions end. **Seek care immediately for fever or shivering; for rapidly spreading redness and swelling, pus or a foul smell from the ulcer; for sudden severe foot pain, or a cold, pale foot or blue toes; for new blackening of the skin; for severe ear pain, bleeding from the ear or hearing loss; for shortness of breath or chest pain; or for a seizure or twitching.**
Expected duration
A single session usually lasts sixty to one hundred and twenty minutes, plus preparation and observation time. It is a programme rather than one visit, typically about twenty to forty sessions at roughly one per weekday, with the ulcer re-measured at intervals to decide whether continuing is justified.
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