Point: hyperbaric oxygen is beneficial for diabetic foot wounds.

Diabetic foot ulcers occur in 1.9% of adults with diabetes annually [1], resulting in amputation in 15%– 20% of patients within 5 years [2]. Direct medical costs for diabetic ulcer care represent the majority of the estimated $4.6–$13.7 billion US annual expenditure for diabetic peripheral neuropathy [3]. Even modest improvements in the prevention and therapy of diabetic foot ulcers have the potential to substantially impact such costs, largely because of the avoidance of major amputation. The physiology that results in ulceration in the diabetic foot has been extensively reviewed [4]. Loss of nociceptive and autonomic nerves results in a dry, hyperkeratotic surface that is subject to mechanical cracking, infection, and tissue destruction. Local ischemia, age, and tissue reinjury result in chronic, nonhealing wounds that remain a portal of entry for deep-tissue infection. Such infections are a common cause of hospital admission for diabetic patients and are the most common reason for infectious diseases consultation in this population. Evidence-based guidelines for treatment of the infected diabetic foot have emphasized conventional mechanical and antimicrobial therapies [5]. Of the adjunctive therapies available for treatment, only the use of granulocyte colony-stimulating factor in actively infected ulcers and the use of hyperbaric oxygen therapy in refractory ulcers were considered to