Pitfalls of Intralesional Ozone Injection in Diabetic Foot Ulcers: A Case Study
Uzun G, Mutluoğlu M, Karagöz H, Memiş A, et al. Journal of the American College of Clinical Wound Specialists, 2012.
- Study type
- Case report
- People studied
- 1 person
- Population
- 67-year-old woman with type 2 diabetes for 22 years and a 1 x 2 cm toe ulcer, treated at an ozone therapy center with topical ozone, major autohemotherapy, and intralesional injections
- Published
- 2012, Journal of the American College of Clinical Wound Specialists
- Identifiers
- PMID 26199878, DOI 10.1016/j.jccw.2014.01.001
What the authors reported
After a week of topical ozone and major autohemotherapy failed, a physician at an ozone therapy center injected ozone into a 1 x 2 cm toe ulcer. After the second daily injection redness spread to the sole, and within two days the forefoot was necrotic. Healing took debridement, intravenous antibiotics, hyperbaric oxygen, a failed skin graft with fourth-toe amputation, and a great-toe fillet flap.
What limits this result
Single case report. The ozone concentration and volume of the injections are not reported. The ulcer already had surrounding erythema and swelling before the ozone treatments, and glycemic control was poor on admission (HbA1c 11%). The last reported follow-up was at two months.
Harms reported after ozone therapy, and studies of how ozone exposure affects health. One study rarely settles a medical question; our guides weigh each paper against the rest of the evidence.
How the study was done
- Design
- Case study (single patient)
Pitfalls of Intralesional Ozone Injection in Diabetic Foot Ulcers: A Case Study
- Setting
- Department of Underwater and Hyperbaric Medicine, Gülhane Military Medical Academy Haydarpaşa Teaching Hospital, Istanbul, Turkey (author affiliation); the ozone was given at an ozone therapy center
- Read from
- Read from the full text of the paper. Read on October 2, 2026.
Source: Abstract on PubMed
Study arms
| Group | Participants | What they received |
|---|---|---|
| Single patient | Not reported | Ozone treatments at an ozone therapy center from a physical medicine and rehabilitation specialist: topical ozone and major autohemotherapy, then intralesional injections |
Source: Full text on PubMed Central
Procedure as reported
- Sessions
- Topical ozone and major autohemotherapy for seven days, then daily intralesional injections; the event followed the second injection
Although she received topical ozone therapy and major autohemotherapy for seven days, the results were far from satisfactory.
In the paper's own units, not converted.
Source: Full text on PubMed Central
What it measured
- Ulcer when ozone treatment began
- 1 x 2 cm ulcer on the fourth toe
Her medical records at the ozone therapy center revealed an ulcer with 1 × 2 cm size on the fourth toe at her admission.
- Intralesional injection
- Very painful
- After the second daily injection
- Worse pain and redness around the wound, spreading to the sole the next day
Following the second daily injection, the pain grew worse and the patient noticed redness around the wound, which spread to the plantar surface of the foot the following day.
- Within two days
- Large necrotic, edematous wound of the forefoot
- Examination at the wound care center
- 7 x 10 cm skin necrosis on the sole
Upon physical examination, she had skin necrosis (7 × 10 cm) on the plantar surface of the foot.
- Inflammatory markers on admission
- WBC 12.900/μl, CRP 94.5 mg/L, ESR 67 mm/h
Admission inflammatory markers were elevated: WBC: 12.900/μl, C-reactive protein (CRP): 94.5 mg/L, erythrocyte sedimentation rate (ESR): 67 mm/h
- Treatment
- Surgical debridement, culture-driven intravenous antibiotics, aggressive glycemic control, and daily dressings
A comprehensive treatment scheme comprising surgical debridement of necrotic tissues, culture-driven intravenous antibiotic regimen, aggressive glycemic control and daily wound dressings were commenced.
- Result after reconstruction (skin graft failed; great-toe fillet flap)
- Complete healing
Source: Full text on PubMed Central
Safety as reported
Severe foot necrosis and infection after intralesional ozone injections for a non-healing wound
Source: Abstract on PubMed
Follow-up
Two months (follow-up photograph)The patient's picture, which was taken at the two-month follow-up meeting
Source: Full text on PubMed Central
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