Treatment
Wound care clinic visits: what happens and how often
What happens at a wound care visit, how often you’re seen, what you do at home, and when wound care steps up to surgery.
Medically reviewed by Dr. Efe Ozturk · Last reviewed
A foot wound does best with regular visits: cleaned, measured and protected, with a plan that changes if progress stalls.
Dr. Efe Ozturk, a Foot and Ankle Surgeon, is board certified in wound care (FAPWH) and in podiatric medicine (DABPM). Our Lyndhurst, Paramus and Millburn offices all offer wound care.
Who wound care visits are for
This page focuses on diabetic foot ulcers, but we also treat heel ulcers, surgical wounds that have opened, puncture wounds and venous leg ulcers. Compression heals more venous ulcers than no compression,[6] and we start it once we’ve checked that your blood flow allows it.
Your first visit
First we find out why the wound opened and what keeps it open.
- Your story: how long the wound has been there, what has been tried, your diabetes, kidney health, smoking, medicines and shoes.
- The wound: we measure its length, width and depth. Infection is diagnosed mainly from the exam, by signs of inflammation such as redness, swelling and sometimes pus.[1]
- Blood flow: about half of people with diabetes and a foot ulcer also have peripheral artery disease (PAD).[7] We check your pulses and do noninvasive circulation testing at our practice. If blood flow looks reduced, we arrange detailed imaging with a vascular specialist. See circulation tests.
- Imaging and bone: X-ray and ultrasound are done at our practice. MRI, arranged at an outside imaging center, helps most when the exam and X-ray leave doubt about bone infection, and a bone biopsy with culture remains the most reliable test.[1] Dr. Ozturk performs bone biopsies when needed.
No randomized trial supports culturing every ulcer,[1] so we culture a wound that looks infected, using a tissue sample rather than a swab. If it is infected, we start antibiotics and adjust them to the result.[8] See how a foot wound is evaluated.
What happens at a typical visit
Debridement. We trim callus, dead tissue and debris from the wound and its edges, a standard step that helps an ulcer heal.[1] If an uninfected wound has severely reduced blood flow, we hold off on debriding it.[8] See wound debridement.
Measuring. We measure the wound every visit, so progress is a number, not a guess.
Dressings. The choice depends on where the wound is, how inflamed it is and how much it drains; the aim is a moist wound without soggy skin.[1] We teach you or a family member how to change it.
Offloading. For a nerve-related diabetic ulcer under the forefoot or midfoot, the first-choice device is knee-high and can’t be taken off, unless infection or reduced blood flow is more than mild, or both are present; then a removable one is suggested.[5] Pooled across 14 trials, non-removable devices healed 81.9% of ulcers, against 66.1% with removable ones.[1] We fit the device, show you how to get around safely and check it each visit. See total contact casting.
How often you’re seen, and for how long
Visits are usually every week or two while the wound heals, and sooner at any sign of infection.
About 30% to 40% of diabetic foot ulcers heal within 12 weeks.[1] In a trial of 203 people seen weekly, 58% of those whose ulcer shrank more than the median by four weeks healed by 12 weeks, against 9% of the rest. The authors proposed four weeks as a decision point.[3] A wound that isn’t clearly shrinking by then gets a fresh look.
Between visits: your part at home
- If your device is removable, wear it whenever you stand, even for short trips at night. In one small study, people wore their removable boot for only 28% of their daily activity.[1]
- Keep the wound covered, and change the dressing as we showed you.[9]
- Keep your blood sugar in range and eat a balanced diet with enough protein. Higher A1c has been linked to amputation.[1] Protein, vitamin and mineral supplements haven’t clearly improved healing in trials, and guidelines advise against using them to speed healing.[10,4]
- Stop smoking, which can lower blood flow to the feet.[9]
- Check both feet daily, with a mirror if needed. When feeling is reduced, you may not notice a blister or a pebble in your sock.[9] See peripheral neuropathy (external site) at the Nerve Institute.
When we step up: procedures and surgery
Wound care is the foundation. When a wound is stuck, we look for the cause: a bone or tendon pressing on it, infection beneath the surface, or poor blood flow. As a surgeon, Dr. Ozturk can treat that cause directly.
Removing the pressure point. When a device alone hasn’t closed an ulcer under the ball of the foot, the International Working Group on the Diabetic Foot (IWGDF) says to consider surgery, such as lengthening the Achilles tendon or removing a metatarsal head. For an ulcer at the tip or underside of a bent but flexible smaller toe, it recommends releasing the tendon that curls the toe.[5] Dr. Ozturk performs these, plus exostectomy to remove a bony bump, for the ulcers that need them. See surgery that takes pressure off ulcers.
Clearing infection. Some infections reach deep tissue and need surgery, and early treatment lowers the chance of a hospital stay or amputation.[1] Dr. Ozturk drains infection and removes dead tissue and infected bone. See surgery for diabetic foot infection.
Restoring blood flow. Severely reduced blood flow calls for a vascular referral right away. With any PAD, a referral should also be considered if the ulcer hasn’t healed after 4 to 6 weeks of offloading and debridement.[1] We refer you and plan wound care around the procedure. See restoring blood flow.
Add-on treatments and closing the wound. For wounds that standard care alone hasn’t closed, the IWGDF conditionally supports several add-ons, including placental-derived products, hyperbaric oxygen for ulcers with reduced blood flow, and negative-pressure therapy for wounds after surgery. It rates the evidence as poor overall.[4] For the wounds that need them, we apply placental-tissue grafts and other skin substitutes in the office, use negative-pressure wound therapy after surgery, and refer you for hyperbaric oxygen when your ulcer qualifies. Once a wound is clean and has good blood flow, Dr. Ozturk can close it with a skin graft or local flap. See limb salvage surgery and, if amputation has been suggested, a second opinion.
Limits to know about
Not every wound closes on time: about 23% of diabetic foot ulcers are still open at 12 months.[1] And an estimated 42% of people develop another ulcer within a year of healing.[1] Every operation also has risks, which we go over with you before you decide. After healing, we move you into protective shoes (external site) and regular check-ups; see keeping your foot in remission.
Questions to ask at your visit
- Is my wound smaller than last time?
- Is my blood flow good enough to heal it?
- What is the plan if it isn’t smaller in four weeks?
- Would surgery help it heal or stay healed?
When to seek care
See us within a day or two for any foot wound that isn’t healing, especially if you have diabetes. To book, call 908-215-5953 or use Zocdoc.
References
- 1.Armstrong DG, Tan TW, Boulton AJM, et al. Diabetic Foot Ulcers: A Review. JAMA. 2023;330(1):62-75. PubMed 37395769 (external site)
- 2.Nube VL, White JM, Brewer K, et al. A Randomized Trial Comparing Weekly With Every Second Week Sharp Debridement in People With Diabetes-Related Foot Ulcers Shows Similar Healing Outcomes: Potential Benefit to Resource Utilization. Diabetes Care. 2021;44(12):e203-e205. PubMed 34675055 (external site)
- 3.Sheehan P, Jones P, Caselli A, et al. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003;26(6):1879-82. PubMed 12766127 (external site)
- 4.Chen P, Vilorio NC, Dhatariya K, Jeffcoate W, Lobmann R, McIntosh C, et al. Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3644. PubMed 37232034 (external site)
- 5.Bus SA, Armstrong DG, Crews RT, Gooday C, Jarl G, Kirketerp-Moller K, et al. Guidelines on offloading foot ulcers in persons with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3647. PubMed 37226568 (external site)
- 6.O'Meara S, Cullum N, Nelson EA, et al. Compression for venous leg ulcers. Cochrane Database Syst Rev. 2012;11(11):CD000265. PubMed 23152202 (external site)
- 7.Fitridge R, Chuter V, Mills J, Hinchliffe R, Azuma N, Behrendt CA, et al. The intersocietal IWGDF, ESVS, SVS guidelines on peripheral artery disease in people with diabetes and a foot ulcer. Diabetes Metab Res Rev. 2024;40(3):e3686. PubMed 37726988 (external site)
- 8.Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Fitridge R, Game F, et al. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3657. PubMed 37243927 (external site)
- 9.National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes and Foot Problems. niddk.nih.gov (external site)
- 10.Moore ZE, Corcoran MA, Patton D. Nutritional interventions for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev. 2020;7(7):CD011378. PubMed 32677037 (external site)
This page is general health information and isn’t a substitute for advice from a clinician who knows your history. Read our medical disclaimer and how we review content.
Questions patients ask
Articles from our blog on healing a wound, protecting the foot and the surgery that saves it, with the sources listed.
Ulcers & offloading
Why a Foot Wound Deserves Prompt, Thorough Care
A painless sore on the foot can be more serious than it looks. What the research shows about waiting, what thorough wound care covers, and when surgery is the step that saves the foot.
8 min read
Related topics
Treatment
Wound debridement
Removing callus and dead tissue from a foot wound, in the office or the operating room, so the wound can heal.
Treatment
Total contact casting
A knee-high cast or locked walker you can’t take off, which spreads pressure away from a foot ulcer so it can heal.
Diagnosis guide
How wounds are evaluated
How a foot wound is evaluated, from the exam and measurements to the probe-to-bone test, cultures, X-rays, MRI, bone biopsy and circulation checks.
Treatment
Limb salvage surgery
Operations that clear infection, remove infected bone, take pressure off ulcers, rebuild collapsed feet and close wounds, with the aim of saving the foot and keeping you walking.
Condition
Diabetic foot ulcers
Open sores on the feet of people with diabetes, and the step-by-step care, including surgery when it’s needed, that aims to heal them and keep them closed.