A wound on the foot or lower leg that has not closed is a circulation question before it is a dressing question. The most common reason a wound will not heal is that not enough blood is reaching it — and no dressing solves that.
Get seen today if
- There is spreading redness, or redness with fever, chills or feeling unwell — call 911 or go to an emergency department if you feel confused or very unwell
- The wound is getting bigger, more painful, wetter, or starting to smell
- There is a dark, black or leathery patch on a toe, heel or the side of the foot
- You can see bone or tendon in the base of the wound
- You have diabetes and any new break in the skin of the foot — the threshold is lower, not higher
The rule of thumb
A break in the skin below the knee that has not closed in about two weeks, or that is getting worse at any point, should be assessed. Not re-dressed — assessed, with the circulation checked. Waiting to see whether it turns a corner is how small wounds become large ones.
Why wounds stall
| Reason | What it looks like | What it needs |
|---|---|---|
| Not enough arterial blood | Toes, heel or bony points; dry, pale or black base; often very painful; cool foot, weak pulses | Arterial assessment, and often revascularization — healing depends on it |
| Venous pressure | Inner ankle; shallow, irregular, weeping; brown staining and swelling around it | Compression bandaging by a trained clinician, plus wound care |
| Pressure and no sensation | Under the ball of the foot, the heel, or the tip of a toe; often painless, with thick callus around it | Offloading — taking pressure off it — and footwear |
| Infection | Increasing redness, warmth, swelling, pain, discharge, odor | Antibiotics, sometimes surgical drainage; assessment for bone involvement |
| Lymphatic swelling | Firm swollen limb, skin folds, repeated cellulitis | Lymphedema management alongside wound care |
| Something else | Unusual appearance, unusual site, not responding to correct treatment | Reassessment, sometimes biopsy — a small number are not ordinary wounds at all |
More than one is often true at once. A diabetic foot ulcer frequently combines pressure, no sensation, poor arterial supply and infection, and each element needs addressing.
The part most people are not told
Before anything else, the question is: is there enough blood supply for this to heal at all? Dressings, antibiotics and offloading all assume that the answer is yes. If it is no, the wound will not close however good the dressing, and the priority becomes restoring blood flow. That is why a non-healing wound below the knee should get an arterial assessment early rather than after several months of dressings.
What a proper assessment involves
- Arterial check — pulses, ABI, toe pressure, and imaging where needed.
- Wound assessment — site, size, depth, base, edges, discharge, whether it probes to bone.
- Sensation testing, because a painless wound tells you something important.
- Infection assessment, and X-ray or other imaging if bone involvement is a possibility.
- Cause-specific treatment: revascularization, compression, offloading, antibiotics, debridement — chosen by what the assessment found.
- Follow-up with measurement. A wound that is not smaller over four weeks of correct treatment is a reason to re-examine the diagnosis, not to continue.
While you wait for the appointment
- Keep it clean and covered with a simple dressing.
- Keep weight off it if it is on the sole or a pressure point.
- Do not use corn or callus removers, strong antiseptics, or home remedies on an open wound.
- Do not apply compression that nobody has assessed you for.
- Do not soak it. Soaking softens and macerates the surrounding skin.
- Photograph it, with something for scale, so change is visible rather than remembered.
Common questions
How long should a wound take to heal?
A simple break in the skin on a healthy leg generally shows clear progress within one to two weeks. Anything below the knee still open at two weeks, or open and not visibly improving, has earned an assessment. Chronic wounds are judged by whether they are measurably smaller over four weeks of correct treatment.
It does not hurt. Is that good?
No — and it is one of the more dangerous reassurances there is. A painless foot wound usually means reduced sensation, which means nothing will warn you if it gets worse. Painless wounds need more vigilance, not less.
Should I let it air out?
Generally no. Wounds heal better in a moist, covered environment than dried out under a scab, and covering protects from knocks and contamination. Which dressing suits depends on the wound, which is another reason to have it looked at.
Can I just get antibiotics?
Antibiotics treat infection. They do not treat poor blood supply, unrelieved pressure, or venous hypertension — and those are the more common reasons a wound stalls. Repeated antibiotic courses for a wound that keeps not healing is a sign the underlying cause has not been found.
I have diabetes. Is this different?
Yes, in urgency. Reduced sensation, reduced blood supply and higher infection risk often combine, and diabetic foot ulcers can deteriorate quickly and quietly. Any new break in the skin of a diabetic foot should be seen within days, not weeks.
Where to go next
Sources
- NHS. Leg ulcer — diagnosis and treatment.
- National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes and Foot Problems.
- National Heart, Lung, and Blood Institute. PAD — Symptoms.
- Society for Vascular Surgery. Acute Limb Ischemia.
Written by Tom Biernacki, DPM, FACFAS. Published 20 September 2026. General education, not medical advice.