Foot wound care is specialised management of wounds and ulcers on the foot that fail to heal within the expected time. The commonest is the diabetic foot ulcer, followed by wounds caused by poor arterial supply, pressure ulcers in people with limited mobility, and wounds after injury or friction from ill-fitting footwear. The aim is not simply to cover the wound, but to prevent deep infection and preserve the foot and its function. The greatest danger is that many of these wounds do not hurt. Nerve damage in diabetes removes the sensation of pricking, pressure and heat, so an ulcer forms and enlarges without obvious pain and the patient presents late, once infection has reached deep tissue or bone. Absence of pain therefore does not mean the wound is minor, and regular foot checks for people with diabetes are a basic preventive measure. Assessment covers the size and depth of the wound, whether there is dead tissue, tunnelling or exposed bone, the foot pulses and signs of perfusion, sensation testing, and a review of diabetes control. A deep tissue culture, bone imaging or vascular assessment may be needed. This assessment determines the treatment plan, and suitability for any procedure is decided by clinical examination, not by reading about it. Treatment is a set of elements that work together: cleaning the wound and removing dead tissue in stages, choosing a dressing that matches the wound bed and the amount of exudate, offloading pressure from the ulcer site with special footwear, a cast or crutches, treating infection when present, improving blood supply with vascular surgery input if pulses are weak, and optimising blood sugar, nutrition and smoking cessation. Deep or infected wounds may require debridement in the operating room, negative-pressure therapy or skin grafting. Limits of the procedure: no advanced dressing, cream or ointment will heal a wound on a foot with poor blood supply or under continuing pressure. Without offloading and improved perfusion the wound stays open, however expensive the dressing. Antibiotics treat infection; they do not close a wound and should not be used without indication. Healing is also not permanent safety: going back to the old shoes or walking barefoot brings the ulcer back in the same place. Several harmful and widespread myths also need correcting: do not use a blade, scissors, a sharp file or caustic corn plasters to remove dead skin and callus at home, do not soak the foot in hot water, do not apply herbs, toothpaste, ash or coloured preparations to the wound, and do not wrap the foot in a tight bandage yourself. These are repeated causes of deep infection and tissue loss, and coloured preparations hide important changes from the doctor's eye.
Procedure steps
- 1
Assessing the wound and the whole foot
The wound is measured and its depth documented, along with any tunnelling, exposed bone, dead tissue or odour. The whole foot is examined, including between the toes, bony deformities and pressure points, and the shoe itself is inspected, since footwear is a frequent cause of ulceration.
- 2
Assessing perfusion, sensation and infection
Foot pulses, skin colour and temperature and capillary refill are checked, sensation is tested with simple instruments, and local and systemic signs of infection are assessed. When deep infection is suspected, a deep tissue culture and imaging are requested, and referral for vascular assessment may follow.
- 3
Cleaning and debridement
The wound margins are cleaned and dead tissue, slough and surrounding callus are removed to expose healthy tissue capable of healing. This may be done over several clinic sessions, or in the operating room if the wound is deep, painful or extensive.
- 4
Appropriate dressing and offloading
A dressing is chosen to suit the wound bed and the level of exudate and to maintain balanced moisture, and a change schedule is set. Most important is offloading the ulcer site with therapeutic footwear, a cast, an insole or crutches, because continuing to walk on the ulcer prevents healing.
- 5
Follow-up and preventing recurrence
Measurements are tracked at every visit to compare progress, infection is treated, and diabetes control and nutrition are corrected. After healing, suitable footwear and insoles are prescribed, the patient is taught daily self-inspection of the feet, and regular review is scheduled because recurrence is common.
Before the procedure
Do not wait for the wound to hurt: seek review early and book an appointment as soon as an ulcer, colour change or swelling appears on the foot. Before the visit wash the foot with lukewarm water and mild soap and dry it carefully, especially between the toes, and apply no coloured preparations, herbs, toothpaste or unprescribed ointment, as these hide the state of the wound from the doctor. Do not try to cut away dead skin or callus yourself and do not soak the foot in hot water. Bring the shoes and socks you normally wear, since examining them is part of the diagnosis, and bring your medication list, recent blood sugar readings, latest laboratory results and any previous reports or foot imaging. Tell the doctor how long the wound has been there, whether there is discharge or odour, whether you have had a fever, whether you have numbness or loss of sensation, whether you smoke, and whether you get calf pain when walking.
After the procedure
Change the dressing exactly as instructed and on schedule, wash your hands before and after, use no dressing other than the one prescribed, and never wrap it tightly, which would impair circulation. Stick to offloading: use the therapeutic shoe, cast or crutches for every step indoors and outdoors, because walking without offloading reopens the wound. Inspect both feet once a day in good light using a mirror, checking between the toes and the heel. Never walk barefoot, feel inside your shoes with your hand before putting them on, and cut nails straight across or have a professional do it. Optimise blood sugar, nutrition and protein intake, and stop smoking, which narrows vessels and delays healing. Keep every follow-up appointment even if the wound looks better. **Seek care immediately if you develop: spreading redness around the wound, increasing warmth or swelling, pus or a foul odour, new or sudden pain, blackening or blueness of the toes or around the wound, a cold pale foot, fever or shivering, unexplained high blood sugar, or a new blister or wound.**
Expected duration
A clinic assessment and debridement session usually takes 20 to 45 minutes and is repeated weekly or more often; ulcer healing typically takes weeks to months depending on perfusion, offloading and infection.
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