Foot and ankle wound care

Wounds we treat

• Diabetic foot ulcers, usually on the sole or toes where pressure is highest.^[1]
• Pressure injuries on the heels and ankles from lying or sitting in one position.
• Wounds from poor circulation, which may need a vascular specialist as well.^[4]
• Post-surgical and traumatic wounds that are slow to heal.
• Infected wounds, from a small blister to a deep infection involving bone.^[5]

How we evaluate a wound

We measure the wound and assess its depth, what is at its base and whether it reaches bone; look for infection; check sensation and circulation (pulses, and further vascular testing if needed); and find the source of pressure, such as a deformity, a shoe or how you walk. X-rays at the practice help look for bone infection and foreign bodies.^[2,5,4]

Treatment

Evidence-based wound care follows the same principles in every wound:

• Offloading. For diabetic foot ulcers, taking pressure off the wound is essential. International guidelines recommend a non-removable knee-high device (such as a total contact cast or a boot made non-removable) as first choice for many plantar ulcers, with removable boots, footwear and felt padding as alternatives.^[6]
• Debridement. Regularly removing dead tissue and callus so the wound can heal.^[2]
• Dressings chosen for the wound’s moisture, depth and infection risk.
• Treating infection with antibiotics based on culture results, and surgery when infection is deep or involves bone.^[5]
• Restoring circulation, by referral for vascular assessment and treatment when blood flow is poor.^[4]
• Advanced therapies for wounds that don’t respond to good standard care. Guidelines support some specific interventions to enhance healing, alongside, not instead of, the basics.^[3]
• Blood sugar control and nutrition, coordinated with your primary care physician or endocrinologist.

Common questions

Can I walk on the wound?

As little as possible. Taking pressure off a foot ulcer is arguably the single most important part of healing it, which is why guidelines make a knee-high device that can’t be taken off the first choice for many ulcers on the sole.^[6] We fit the device and show you how to get around safely.

How often will I need to come in?

Usually every week or two while the wound is healing, so that we can clean and trim it, measure its progress and adjust the plan. We see you sooner if there is any sign of infection.

The wound keeps coming back in the same place. Why?

Almost always because the pressure that caused it is still there, from a bent toe, a prominent bone or a tight Achilles tendon. When padding, footwear and offloading devices can’t solve it, guidelines support small operations that remove the pressure point, such as releasing the tendon that bends a flexible toe or lengthening the Achilles tendon.^[6]

Are advanced treatments right for me?

Some are, when good standard care hasn’t healed the wound on its own. Guidelines give conditional support to several, including certain specialized dressings, placental tissue products, a patch made from your own blood cells, topical oxygen and hyperbaric oxygen, and stress that the evidence is still limited.^[3] We discuss whether any of them fits your wound.

After it heals

A healed ulcer is at high risk of coming back. Protective footwear, custom inserts, regular foot checks and early treatment of calluses and pre-ulcer signs reduce the risk.^[7] See diabetic foot care and our article on foot wounds that won’t heal.

When to seek care