An Overview of Ozone Therapy for Treating Foot Ulcers in Patients With Diabetes

Background: why diabetic foot ulcers are so hard to heal

Foot ulcers are among the most serious complications of diabetes. Sustained high blood glucose damages small blood vessels and peripheral nerves, so the tissue of the foot receives less oxygen, loses sensation and heals slowly. Minor injuries can progress to chronic, non-healing wounds that become infected and, in the worst cases, lead to amputation. Standard care - controlling blood glucose, offloading pressure, debridement, dressings and treating infection - does not always close these wounds, which has prompted interest in adjunctive options such as ozone therapy.

What this review covers

This is a narrative review by Wen and Chen that gathers the available laboratory and clinical evidence on ozone as an add-on treatment for diabetic foot ulcers. The authors set out the proposed biological mechanisms - how ozone may influence oxygen delivery, oxidative-stress signalling, circulation and microbial control in wound tissue - and survey how ozone has been applied in practice, including topical gas or bagging, ozonated oils and water, and systemic routes. It synthesises prior studies rather than reporting a new trial with its own patients.

Findings: what the review reports

Across the studies reviewed, ozone is described as having the potential to support wound healing through several routes: improving local oxygen availability, moderating oxidative stress, stimulating the body's antioxidant defences, supporting blood flow and acting against bacteria in the wound. Reported clinical experience suggests ozone may help some diabetic foot ulcers when used alongside conventional care. The authors are careful to note, however, that the mechanisms are not fully understood and that the evidence base is mixed and limited in quality.

What the authors concluded

Wen and Chen conclude that the mechanisms of ozone have not been completely elucidated and that a safe, standardised dose - the therapeutic window that maximises benefit while minimising the risk of toxicity - has not been established. They advise that ozone should be applied with caution as an adjunct, generally after conventional management strategies have failed, and they call for more controlled clinical trials before its role in treating diabetic foot ulcers can be confirmed.

Limitations of this study

As a narrative review, this paper summarises existing literature and does not itself test ozone in a controlled way, so it inherits the biases and gaps of the studies it draws on. The underlying evidence includes small studies and varied protocols, ozone dosing and delivery methods are not standardised, and long-term safety data are limited. The authors' own caution - that mechanisms remain unclear and that more controlled trials are needed - should be read as a limit on how firmly any benefit can be claimed. Ozone therapy is a complementary approach and should be discussed with the clinical team managing a person's diabetes and wound care.