Why Some Foot Wounds Stall

A foot wound that has stopped improving does not need more waiting. It needs a better question. This page sets out a yardstick for judging care of a wound that will not close, so a changed plan is easy to tell from more of the same.

A stalled wound should change the plan

PubMed Central (NIH) carries a paper stating that diabetic foot ulcers readily become chronic, and that all too often these wounds do not heal primarily. Read that as a reason to hold care to a firm standard. A wound that is not getting smaller earns a decision, not the same dressing and another week. Someone measures it, writes the measurement down and compares it with the last visit. The APMA page on diabetic wound care is a published reference for what that care involves.

Reading the wound: working versus stalled

Working care leaves a trail. The wound is measured at each visit, the plan is written down, and you know whom to call between visits.

Stalled care leaves a different trail. Nobody measures. The same instructions repeat while the wound looks the same, and no one has said what a stalled wound would look like or what happens then.

The shortcut: more of the same

The common shortcut is to keep doing what has not worked and call it patience. It costs the wound a decision date, because without one nobody ever has to change course. If the plan has not changed since the first visit, ask what else is on the table. Published research is one place to see the range, for example this PubMed Central paper on wound-healing peptides for chronic diabetic foot ulcers and other infected skin injuries.

What each follow-up must do

Each follow-up should do the same three things. It measures the wound, compares the number with the last visit, and ends with a spoken decision to continue, change or refer. If a visit ends with "keep an eye on it" and nothing else, the follow-up did not happen.

The question that exposes a stalled plan

Ask: "If the wound looks the same next time, what will we do differently?" A real plan has an answer and a date. For a longer read on chronic wounds in diabetes, try the PubMed Central paper on current aspects of chronic wounds in diabetes mellitus.