A sore on the foot that will not heal is not only an inconvenience; in people with diabetes, it may be the first sign that the limb is not getting enough blood. When circulation falters, even small breaks in skin may fail to close, infections spread rapidly, and tissue can progress from threatened to unsalvageable in weeks rather than months. Early recognition of vascular causes transforms the clinical picture from reactive wound care to proactive limb rescue.
We spoke to Dr Siddharth M, Consultant Vascular and Endovascular Surgeon, Gleneagles BGS Hospital, Bengaluru, who explained how non-healing foot wounds could be a vascular emergency.
Warning Signs Your Foot Wound May Be Vascular
Not every slow-healing ulcer is vascular, but there are telltale patterns. Here are some listed by the expert:
- Wounds on the toes or tips of the foot
- Pale or dusky skin around an ulcer
- Pain at rest (worse at night)
- Foot that feels cool to touch
These symptoms point towards reduced arterial inflow.
Pulses that are weak or absent and delayed capillary refill are practical bedside clues. In contrast, a warm, red, swollen foot usually signals infection or venous problems — different emergencies, but both deserving urgent assessment.
Diagnostic Tests for Non-Healing Foot Wounds
Simple, non-invasive tests are powerful triage tools.
- The Ankle-Brachial Index (ABI) gives a quick estimate of large-vessel blood flow, toe pressures or Toe-Brachial Index (TBI) are more reliable when ankle vessels are calcified, as often occurs in diabetes.
- Duplex ultrasound maps flow and localises blockages
- Advanced imaging (CT angiography or catheter angiography) guides definitive revascularisation.
Guidelines recommend vascular imaging if a diabetic foot ulcer doesn’t improve after four to six weeks of proper wound care, as waiting longer can reduce the chances of saving the limb.
Also Read: How To Know If Numbness In Your Feet Is A Sign Of Diabetes?
When Should Vascular Imaging Be Done for Foot Ulcers?
“When arterial insufficiency is confirmed, restoring in-line blood flow is central to healing. Endovascular techniques (angioplasty, stenting), open bypass surgery, or hybrid approaches each have a role depending on anatomy and patient factors,” said Dr Siddharth.
Contemporary evidence and consensus statements support revascularisation to prevent limb loss in chronic limb-threatening ischaemia and to improve ulcer healing when peripheral artery disease is present. Outcomes improve when revascularisation is performed by experienced teams working within limb-salvage pathways.
Why a Multidisciplinary Team Approach Improves Outcomes
“Successful limb preservation rarely rests on a single intervention. Off-loading pressure from the ulcer, meticulous infection control, optimising blood glucose, and correcting nutrition and anaemia are all essential alongside vascular care,” added Dr Siddharth.
Multidisciplinary limb-salvage teams, involving diabetology, vascular surgery, interventional radiology, podiatry, and wound nursing, streamline timely imaging, revascularisation, and wound management, according to a 2015 study.
Guidelines consistently recommend early referral to such teams when ischaemia is suspected or a wound fails to progress despite standard therapy.
Red Flags that Need Urgent Action
Seek urgent medical attention if you notice:
- Sudden worsening of pain
- Rapidly spreading redness or foul-smelling drainage
- Sudden increase in swelling
- Systemic signs like fever or confusion
- Colour changes in toes (mottling or blackening)
Chronic ulcer warning:
- No significant improvement after four weeks of proper care (including off-loading and infection control)
- Requires urgent vascular imaging and referral to a specialist
Why it matters:
- Delays can mean the difference between saving the limb and amputation—sometimes within weeks.
Prevention and Patient Actions that Preserve Limbs
To reduce the risk of ulcers and limb-threatening complications, patients and clinicians can take these preventive steps:
Regular Monitoring and Care:
- Inspect feet daily
- Maintain proper hygiene
- Treat minor wounds promptly
Lifestyle and Health Management:
- Quit smoking
- Keep blood sugar under control
- Manage blood pressure and cholesterol
Preventive Measures:
- Wear appropriate footwear
- Seek early care for blisters or cuts to avoid complications
Clinical Guidance:
- Doctors should consider vascular assessment early in any diabetic patient with a new foot lesion
Bottomline
Dr Siddharth concluded, “A non-healing foot wound is more than a local problem; it is a signal that the limb’s blood supply, and therefore its survival, may be at risk. Recognising vascular clues, using focused tests, and moving rapidly to multidisciplinary care and revascularisation where needed preserve tissue, reduce amputations, and restore function. In diabetic foot care, speed and coordination save limbs.”
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your professional if you are dealing with any health issue to avoid complications.]