Why Do Some Foot and Leg Wounds Not Heal?

A foot or leg wound that is not healing may need more than a change of dressing. Wound healing depends on several things working together, including an adequate blood supply, controlled swelling, protection from pressure and appropriate management of infection and underlying health conditions.

In this video, I focus on two questions from a vascular perspective: is enough blood reaching the wound through the arteries, and are the veins draining effectively? These questions can help explain why a wound remains open despite regular care.

When is a wound considered chronic?

In the video, I describe a wound that persists beyond about four weeks as chronic. Definitions vary, and the important point is that a wound which is not progressing needs its underlying cause reviewed.

Four weeks is not a waiting period before seeking help. A new foot wound in someone with diabetes, a worsening wound or signs of infection deserves earlier assessment. Reduced sensation can make a significant wound surprisingly painless.

How can blocked arteries delay healing?

Arteries bring blood carrying oxygen and nutrients to the tissues. If they are narrowed or blocked, the wound may not receive enough blood to repair itself effectively. This is one reason peripheral arterial disease (PAD) matters in foot and leg wound care.

Some people also notice pain when walking, pain at rest or a foot that feels unusually cold. Others have fewer obvious symptoms, particularly if diabetes has affected their nerves. The wound’s appearance alone cannot establish whether the blood supply is adequate.

How can vein problems affect a wound?

Veins return blood from the legs towards the heart. When their one-way valves do not work properly, blood can flow backwards, a problem called venous reflux. Raised venous pressure and swelling can damage the surrounding skin and interfere with healing.

This is a different mechanism from arterial blockage. Someone with venous disease or varicose veins may also have ankle swelling, aching, brownish skin changes or a recurrent ulcer. Arterial and venous problems can occur together, so treatment should follow an assessment rather than an assumption.

What else can prevent a wound from healing?

Circulation is only part of the picture. Factors that may need attention include:

• Diabetes: including glucose control, nerve damage and infection risk.

• Pressure or repeated injury: for example, footwear rubbing the same area.

• Smoking and nutrition: both can affect the body’s ability to repair tissue.

• Medicines and other illnesses: these may influence healing and should be reviewed.

• Infection: which can worsen a wound and become more serious when blood supply is poor.

What does a vascular wound assessment involve?

I would ask how the wound started, how long it has been present and what care it has received. Examination includes the wound, surrounding skin, swelling and foot pulses. Your medical history and medicines help guide further investigation.

Tests may include ankle or toe pressure measurements and duplex ultrasound to assess arterial flow or venous reflux. Further imaging is selected according to the findings. Not every wound requires every test or a procedure.

A treatment plan may combine dressings, pressure relief, management of infection and diabetes, and treatment of a circulation problem where appropriate. Compression can help selected venous ulcers, but its suitability depends on the arterial blood supply. Avoid starting tight bandaging yourself.

Which changes need urgent attention?

Seek urgent medical help for spreading redness, increasing warmth or swelling, pus, worsening pain, fever or black tissue. A suddenly cold, painful, numb or weak foot needs emergency assessment. Do not wait for a routine clinic appointment if the problem is rapidly worsening; call 995 in Singapore for a life-threatening emergency.

Assessment for a non-healing wound in Singapore

For a wound that is slow to heal, contact Andrew Choong Vascular Surgery to discuss assessment at Mount Elizabeth Novena Specialist Centre, #09-22, 38 Irrawaddy Road, Singapore 329563. Understanding the cause helps guide care beyond the dressing itself.

This article provides general education and does not replace an individual medical assessment.