Wound Not Healing

Wound and Skin Breakdown· Also known as: non-healing wound, slow-healing wound, hard-to-heal wound, chronic woundUpdated Oct 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026

At a Glance

A wound that is not healing has stopped moving through the normal stages of repair. It is often a sign of something else going on, such as poor blood flow, diabetes or ongoing pressure on the area. As many as 34 per cent of people with diabetes get an ulcer (open sore) on the sole of the foot at some point. About 80 per cent of leg ulcers come from vein problems. Treatment works best when your podiatrist finds and treats the cause, not just the wound. A wound that hasn't improved after four weeks needs a fresh look.

What is it?

A wound that is not healing is one that has stopped moving through the usual stages of repair in a steady, timely way. It often gets stuck in the first stage, when the area stays swollen and inflamed. You may hear it called a chronic wound or a hard-to-heal wound.

There is no single agreed time for when a wound counts as stuck. A wound that hasn't improved after four weeks of care, or hasn't healed or shrunk by 40 to 50 per cent in that time, needs to be looked at again. The wound is often the visible sign of a problem underneath, so finding that problem is the key.

What can cause it?

Slow healing usually has more than one cause. Underlying disease, poor nutrition and pressure on the area can all play a part. Here are the main types, starting with the commonest.

Venous leg ulcer. About 80 per cent of leg ulcers are venous. They are the outward sign of long-term problems with the veins in the leg (chronic venous disease). They usually appear on the inside of the leg, between the knee and the ankle.

Arterial ulcer. About 15 per cent of leg ulcers are arterial. They are caused by poor blood flow through the arteries (the vessels carrying blood to your legs and feet).

Diabetic foot ulcer. Over time, high blood sugar can damage nerves and blood vessels and keep the area inflamed. All of this slows healing.

Pressure injury. This is a sore that develops when pressure on the skin goes on for too long. It is one of the main types of long-lasting wound.

Other causes. Together, injuries, inflammation of the blood vessels (linked to conditions such as rheumatoid arthritis and lupus) and skin tumours account for about 5 per cent of leg ulcers. Martorell's ulcer is another type. It has dead tissue with a red ring around it, grows quickly and is extremely painful for its size. Wounds can also follow radiation treatment, a leak of chemotherapy medicine from a vein, or a Buruli ulcer (a skin infection).

Who gets it?

It is more common in older adults and in people with diabetes. As many as 34 per cent of people with diabetes get an ulcer on the sole of the foot over their lifetime. Venous leg ulcers often develop in older adults whose leg veins no longer return blood well. Wounds that are hard to heal also tend to occur in people with several health conditions.

Some ulcers last a long time. They can cause pain, make it harder to get around and affect your quality of life.

How is the cause found?

Your podiatrist looks at you as a whole person, not just the wound. They will ask about your health history, including diabetes, circulation problems, earlier ulcers, nutrition and pressure on the area. They will examine your legs, feet and the wound to work out whether the cause is veins, arteries, diabetes, pressure or something less usual.

Checking your blood supply is a key part of this. A test called the ankle-brachial pressure index (ABPI) compares the blood pressure at your ankle with the pressure in your arm. A low reading points to an artery problem, and your podiatrist may refer you to a vascular specialist (a doctor who treats blood vessels). A very high reading can also be a warning, because stiff, hardened vessels can give a falsely high number. This is more likely if you have diabetes or kidney disease.

If you have diabetes, feeling the pulses in your foot isn't enough to rule out poor circulation. Automated ABPI machines can also miss disease, so the result is read alongside your other findings. For a new diabetic foot ulcer, your podiatrist will usually check whether the sore reaches down to the bone with a gentle probe test and arrange X-rays. An MRI scan may follow if an abscess (a pocket of pus) or a bone infection is suspected.

Your podiatrist will also watch for infection. Increasing pain and a growing wound are the two most useful signs that an infection has gone deeper than the surface.

Treatment

Treatment depends on the cause. Looking after the wound itself matters, but treating the reason it isn't healing matters just as much.

Looking after it at home

Follow your podiatrist's advice on dressings and on keeping pressure off the area. Eating enough helps too: your body needs enough calories, protein, vitamins A and C and zinc to heal.

Look at the wound regularly and watch for the warning signs listed under "When to see a podiatrist". If you have diabetes, check your feet regularly and report any new sore early. Don't put on compression bandages or stockings unless a health professional has first checked the blood supply to your leg.

Treatment from your podiatrist

Your podiatrist will check the likely cause and treat it. For a venous ulcer, compression (firm, even pressure from bandages or stockings) is the first line of treatment. It is used only after your arterial blood supply has been checked, and it may be combined with other care for the veins. Compression isn't suitable if you have poor blood flow in the arteries, because it can make that worse. It also isn't suitable if you have fluid on the lungs.

For a diabetic foot ulcer, standard care has several parts that work together:

Good blood sugar control.

Debridement (removing dead or unhealthy tissue from the wound).

Treating any infection.

Offloading (taking pressure off the sore area).

Advanced dressings.

This care often involves a team, which may include your GP and a diabetes team.

Other options

If your wound hasn't improved after four weeks, your podiatrist will first look again at why. Infection, pressure, poor circulation, nutrition and blood sugar levels are the usual reasons. You may then be referred to a wound clinic or a qualified wound care provider for a closer assessment. A biopsy (a small sample of tissue taken for testing) may be considered.

For advanced arterial ulcers, the first line of treatment is revascularisation. This is a procedure or surgery to restore blood flow, either through the blood vessels or by open surgery. The aim is to reduce pain and keep the leg. For some people with a diabetic foot ulcer, negative pressure wound therapy (a special dressing attached to a pump) or hyperbaric oxygen (breathing oxygen in a pressurised chamber) may be offered. Neither is a cure-all. Each works best as part of a wider plan that includes blood sugar control, infection care and offloading.

Will it get better?

The outlook depends on the type of wound, and these wounds often come back. After a diabetic foot ulcer closes, the risk of another is highest straight away: 40 per cent of people get another within 12 months, and nearly 60 per cent within 3 years. Venous leg ulcers can last a long time, but treating the cause gives them the best chance of healing.

Quick action matters. An infected foot ulcer that isn't treated quickly and well raises the risk of amputation.

Preventing it

After a venous ulcer heals, wearing compression stockings reduces swelling and the chance of it coming back. Stockings are safe and effective for this. The same blood supply checks apply, so have yours checked before you start.

After a diabetic foot ulcer heals, expect close follow-up in the first months, when the risk of it returning is highest. Check your feet regularly, and report any new sore, blister or bruise early, rather than waiting to see if it settles.

When to see a podiatrist

When to book

Book an appointment with your podiatrist if your wound hasn't improved after four weeks of care, or hasn't healed or shrunk by 40 to 50 per cent in that time. It's also worth booking if you have a wound or ulcer on your leg or foot that isn't healing and you don't yet know why.

When to get help sooner

Call your local emergency number if you have a wound or infection and you also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, as this could be sepsis.

These signs of infection need urgent medical assessment: see your GP today, or go to an urgent care clinic or the nearest emergency department. They are more swelling, more redness around the wound, worse pain, hot skin, more or changed discharge, an offensive smell, a fever, or feeling unwell. A foot infection that is turning black and smelly needs the same urgent assessment, without delay.

If you have diabetes and your toe or foot becomes red, hot and swollen, or you notice any danger sign while being treated for a foot ulcer, contact your foot care team, podiatrist or GP as soon as possible, within 24 hours. If none of them is available and your foot shows no sign of healing within 24 hours, go to the nearest emergency department. Also contact your podiatrist or GP right away if you have diabetes and a cut, blister or bruise on your foot that hasn't started to heal after a few days, or if the skin becomes red, warm or painful.

See your GP soon, and don't put it off, if you have an ulcer that is unusually painful for its size, is growing quickly, or doesn't look like a typical ulcer.

Frequently asked questions

What is an ABPI test and why do I need it?

It compares the blood pressure at your ankle with the pressure in your arm to show how well blood is reaching your leg and foot. A low result points to an artery problem, and a very high one can mean stiff, hardened vessels. It guides whether compression is safe, so it is done before compression starts.

Why can't I just start wearing compression on my leg ulcer?

Compression helps venous ulcers, but it can reduce blood supply if your arteries are already narrowed. That could make the wound worse. Your podiatrist checks your blood supply first, so they can choose full compression, lighter compression or none at all, and refer you if needed.

Does a wound that won't heal always mean infection?

No. Infection is one possible reason, but poor circulation, ongoing pressure, nutrition and blood sugar levels can also keep a wound from healing. Your podiatrist checks all of these, because treating the real cause is what gets the wound moving again.