The WHS publishes guidance for clinicians with the goal of improving patient care. The new guidelines for diabetic foot ulcer (DFU) treatment have been updated since its 2016 publication to reflect new, higher-quality evidence. Highlighted in the new guidelines were two Meta-analyses, which include NATROX® O₂ cTOT RCT data.

Notably, the guidance states:

“Topical oxygen has been shown to increase the incidence of healing and decrease the time to heal”.¹

Key Highlights

  • Clinical Validation: The Wound Healing Society recognizes the efficacy of topical oxygen therapy in its latest guidelines.
  • Level 1 Evidence:The WHS designates ‘Level 1’ evidence as “Meta-analysis or at least two RCTs supporting the intervention of the guideline.”
  • Game-Changing Potential:Explore how topical oxygen therapy is reshaping wound care practices and achieving lasting healing results.


  • The WHS guidelines support evidence-based practice to optimise outcomes in patients with diabetic ulcers.
  • Advanced adjuncts, such as topical oxygen therapy, supported by the highest level of evidence (Level 1) should be considered in non-healing wounds due to increased incidence of healing and decreased time to heal following TOT treatment in these wounds.
  • This article builds on evidence from the American Diabetes Association (ADA) which maintains topical oxygen therapy as “Grade A evidence”² in its Standards of Care in Diabetes 2024and Standards of Care in Diabetes 2023. It also adds to the International Working Group for the Diabetic Foot (IWGDF) 2023 Guidelines for DFUs recommend using “topical oxygen therapy as an adjunct to standard of care for wound healing.” ³ 

Next Steps

Dive into the full guidelines for in-depth insights:


  • Lavery, L. A. et al. WHS (Wound Healing Society) guidelines update: Diabetic foot ulcer treatment guidelines. Wound Repair and Regeneration (2023) doi:10.1111/wrr.13133.
  • El Sayed, N. A. et al. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes—2023. Diabetes Care 46, S203–S215 (2023)
  • IWGDF, 2023. Wound healing interventions guideline (2023 update). Available at: https://bit/ly/nwc-iwgdf-guidelines2023