Foot wounds that won’t heal: why, and what wound care involves

Most cuts and scrapes on the feet heal in a week or two. A wound that’s still there after several weeks, or keeps coming back in the same place, is telling you something is getting in the way of healing, and the reason is usually one of a handful of causes.

Why some wounds don’t heal

1. Pressure. Every step presses on a wound on the sole or toes. If you can’t feel it because of neuropathy, you’ll keep walking on it. For diabetic foot ulcers, relieving pressure is one of the most important parts of treatment.^[3]

2. Poor circulation. Wounds need blood flow to heal. About half of people with diabetes and a foot ulcer have peripheral artery disease, which raises the risk of serious problems in the leg and the heart, so it needs to be looked for in every non-healing wound.^[6]

3. Infection. Bacteria in a wound can stall healing and, in a diabetic foot, spread to deeper tissues and bone.^[5]

4. The wound bed itself. Dead tissue and thick callus around the edges keep a wound from closing.^[2]

5. Your overall health. High blood sugar, smoking, poor nutrition, swelling and some medications slow healing.^[1]

What wound care involves

Good wound care treats all of those causes at once.^[2]

• Offloading: for plantar ulcers, international guidelines recommend a non-removable knee-high device, such as a total contact cast, as the first choice for many patients, with removable boots and footwear as alternatives.^[3]
• Debridement: regularly removing dead tissue and callus in the office.
• The right dressing for the wound’s moisture and depth.
• Treating infection: based on cultures, with antibiotics, and with surgery when infection is deep or involves bone.^[5]
• Checking circulation, and referral for vascular treatment when blood flow is poor.^[6]
• Advanced therapies for wounds that haven’t responded to good standard care, used alongside the basics rather than instead of them.^[4]
• Blood sugar, nutrition and smoking, coordinated with your other physicians.

Dr. Ozturk is double board certified: by the American Board of Podiatric Medicine, and in wound care as a Fellow of the Academy of Physicians in Wound Healing (FAPWH). See wound care.

Common questions

Should I let the wound “air out”?

Usually not. Most wounds heal better covered with a dressing that keeps the wound bed moist but not wet, and that protects it from pressure and dirt. We choose the dressing for your wound and show you how to change it.

My foot doesn’t hurt. Is the wound really serious?

It can be. With neuropathy, a wound can be deep or infected and still not hurt, which is exactly why wounds in people with diabetes get worse unnoticed.^[1] Judge a wound by how it looks, not how it feels.

Why do you check my circulation?

Because poor blood flow is common in people with diabetes and foot ulcers, and a wound can’t heal without it.^[6] If the blood flow is reduced, we arrange vascular testing and treatment alongside the wound care.

After it heals

A healed diabetic foot ulcer has a high chance of coming back. Protective shoes and inserts, regular foot checks and early treatment of calluses and blisters are what keep it closed.^[7] Our daily diabetic foot check is a good place to start.

When to see a podiatrist