This document covers the role, current evidence and practicalities of topical oxygen therapy (TOT) in diabetic foot care in the UK. Diabetic foot ulcers (DFUs) are complex chronic wounds that have a major long-term impact on the morbidity, mortality and quality of patients’ lives (Wounds International, 2013).

TOT in wound care has been understood to aid wound healing since the 1960s and has been shown to be especially beneficial for DFUs where there is an ischaemic or a hypoxic element. An Expert Panel gathered in London in early 2019 to discuss the position and appropriate use of TOT in the UK today.

Burden of DFUs 
Diabetic foot disease is just one complication of diabetes mellitus, which can lead to non-healing wounds and amputations if left unmanaged. Unlike other chronic wounds, DFUs are often complicated by other wide-ranging diabetic and metabolic changes, such as neuropathy and vascular disease (Wounds International, 2013), which can make them particularly difficult to manage and heal.

Each year, an estimated 2–2.5% of people with diabetes develop a DFU (Diabetes UK, 2017). In the Burden of Wounds study, it has been estimated that there were 169 000 DFUs across the UK, equating to 5% of adults with diabetes (Guest et al, 2015).

Diabetic foot disease is the largest single reason for hospital admissions among people with diabetes (Boulton et al, 2005). The NHS cost of DFUs is estimated at £1 billion per year (Kerr, 2017; Guest et al, 2018), but this does not include the additional social costs to the patient, such as reduced mobility and sickness absence, which are estimated at £13.9 billion per year. The indirect, intangible costs to the person with diabetic foot disease are also high, with many experiencing a poorer quality of life than those without foot disease (Vileikyte, 2001). Individuals who develop a DFU are also at greater risk of premature death, myocardial infarction and fatal stroke than those without a history of diabetic foot ulceration (Brownrigg et al, 2012).