Why is my foot ulcer not healing?

A diabetic patient asked me the other day, "Dr. Arain, why is this ulcer not closing? I feel like it has been on the bottom of my foot forever!"

An ulceration is a sore or opening in the skin that may be very superficial, or may be very deep and go through the layers of skin, and maybe even down to the bone. This is more common in diabetics, and that is why it is of the utmost importance for people with diabetes to see a podiatrist, or foot and ankle specialist, on a regular basis.

My answer to her question was that there are several reasons why a wound or ulceration will not heal.

The first thing you look at is infection. If the sore is infected, it will never heal. Signs of infection include redness, purulent drainage, pain, or swelling. However, a wound may not look infected, or it may be so deep that the podiatrist can "probe" to bone. If this is the case, the podiatrist may need to take a culture, or scraping, to see if there is indeed bacteria in the wound that is infecting the wound. If in fact an infection is present, then an oral or IV antibiotics will take care of the infection and allow the body to heal.

The second thing to consider is lack of blood flow. If the wound is simply not getting enough blood, then with or without infection, the actual tissue is not getting enough nutrients to allow it to heal. In that case, your podiatrist can work with a vascular specialist to determine why there is lack of blood flow and possibly intervene to improve the bloodflow in order to improve chances of healing.

The third aspect to look at is pressure. A person without diabetes can handle fluctuations in pressure of simple weightbearing or walking, however sometimes due to bony deformities, the pressure of the bone or simply of an ill-fitting shoe will prevent the ulcer from healing. Think of it as "micro-trauma" to the sore. In that case, an accomodation can be made to the shoe or even alter the shoe gear temporarily or permanently in order to relieve pressure.

If all of these issues are resolved and the wound is still present, then look at other factors such as nutrition, and other metabolic issues, and even other impacts on health such as tobacco use or alcohol use. On the other hand, sometimes the wound may need some outside help such as wound care elements. There are many options, including topical gels, and bioengineered skin substitutes.

Remember, if a wound or ulcer is not healing, there has to be a reason, and your podiatrist can help. If you are in the Chicago area, please visit our clinic in Elmhurst, Prairie path foot and ankle clinic at 630-834-FOOT, or our Schaumburg location at Schaumburg Foot and Ankle Clinic 847-985-8380.
Please visit our websites at elmhurstfootdoc.com and schaumburgfootdoc.com