Bone Deep Healing

Aggressive hyperbaric therapy can help heal bones damaged by infection

If you stepped on a nail, how long would it be before you noticed it?

For a person with peripheral neuropathy, or damaged nerves in their feet, it could be all day.

“I once treated a man who stepped on a nail while wearing work boots, and he didn’t know he’d done it until later than night, when he couldn’t get his boot off,” recalls Sonja Lichtenstein, MD, a physician with the Center for Hyperbarics and Wound Care - Moss Creek.

Sonja Lichtenstein  MD 2

Deep wounds to the feet that don’t heal quickly can lead to osteomyelitis, a bacterial infection of the bone. The acute problem can become chronic over time, and can even lead to amputation.

Who Is At Risk?

Dr. Lichtenstein commonly treats osteomyelitis in patients with diabetes. This is because people who have diabetes often also suffer from—you guessed it—peripheral neuropathy. Those with damaged nerves in their feet cannot feel it when they have been injured, and the cause does not necessarily need to be as dramatic as stepping on a nail.

Bone Deep Healing stock 2“People with diabetes might walk barefoot on the beach and get a burn, which can actually create a wound,” explains Lichtenstein, who is board-certified in general surgery and hyperbaric medicine. “The space between the skin and the bone on the bottom of your feet is not that far. Or it could be something as simple as a person getting a new pair of shoes, and they have no idea that the shoes don’t fit them well.  They don’t feel the pain and ignore the scratches or blisters that could lead to wounds.”

Other factors, such as infection of bone fractures or infections somewhere else in the body that arrives through the bloodstream, can cause osteomyelitis.  But Dr. Lichtenstein most often sees patients with diabetes who have either allowed the wound to get worse or whose infection is not being controlled.

“Osteomyelitis can often be a very difficult infection to clear,” Lichtenstein says. “If antibiotics cannot control it quickly, we have to get those patients into the hyperbaric chamber as soon as possible.”

Rx O2 

Bone is not as vascular as a person’s skin or subcutaneous tissue, and patients with diabetes often have small vessel disease as well, so the blood supply to their feet is already problematic. This is why treatment in a hyperbaric chamber can help so effectively.

Patients simply lie inside the chamber, and can even sleep or watch television. The chamber provides hyperbaric oxygen (or HBO) therapy, which floods the blood supply with oxygen at greater than normal atmospheric pressure.

“When you have a high of concentration of oxygen in the bone, it actually helps stimulate cells within the bone called osteoclasts,” Lichtenstein explains. “These bone cells help ‘clean up’ the area by reabsorbing dead bone and removing bony debris. They also help stimulate growth factors for healthy bone.”

The high level of oxygen can also stimulate the effects of certain antibiotics within the bone tissue.

The treatment cycle is typically two hours a day, five days a week, for about four or more weeks. But the time commitment is worth it for patients whose wounds will not clear and who are at risk for osteomyelitis.

“We need to treat aggressively to prevent amputation,” Lichtenstein says. “So we want to get those patients into the chamber as soon as possible.”


St. Joseph’s/Candler’s Center for Hyperbarics and Wound Care provides specialized treatment for chronic or non-healing wounds. Each center features multiple hyperbaric chambers for patient scheduling and convenience. We have two locations in Georgia and a center in Bluffton to serve you.