ConditionSkin, hair & nails
Wound Healing Disorders
Wound healing disorders are problems in the body's normal repair process, so a wound heals too slowly, breaks down, or heals with excessive scar. A wound that has not healed within about 4 weeks is called a chronic wound. The most common causes are diabetes, poor blood flow in the arteries or veins, pressure, infection, poor nutrition, smoking and some medicines. Chronic wounds include diabetic foot ulcers, venous leg ulcers and pressure injuries. Treating the underlying cause is the key to healing.
Also called: Impaired wound healing, chronic wounds, non-healing wounds, delayed wound healing, abnormal scarring
At a glance
- What it is
- Wounds that heal too slowly, reopen, or form abnormal scars.
- Chronic wound
- Not healed in about 4 weeks, or not improving after 2 weeks of proper care.
- Common types
- Diabetic foot ulcers, venous leg ulcers, arterial ulcers, pressure injuries, surgical wound breakdown.
- Main causes
- Diabetes, poor circulation, pressure, infection, malnutrition, smoking, steroids, immune problems.
- Treatment
- Treat the cause, clean and dress the wound, offload pressure, compress swelling, treat infection.
When to get help
Call 911 or go to the ER
- A wound with rapidly spreading redness, severe pain, crackling under the skin, dark or dusky skin, fever and feeling very unwell
- A foot or leg that is cold, pale or blue with a wound
See a doctor within a day or two
- Increasing redness, warmth, swelling, pus or bad smell around a wound
- Red streaks spreading from a wound, or swollen glands
- Any new wound or blister on the foot in someone with diabetes or numb feet
- A surgical wound that opens up or leaks fluid
Book a routine appointment
- A wound that has not healed after 2 to 4 weeks
- A raised, growing scar that is itchy or spreading beyond the wound edges
- A sore that bleeds, heals and reopens, or looks unusual (possible skin cancer)
Usually safe to manage at home
- A small cut or graze that is getting smaller and less red each day
How normal wound healing works
Healing happens in overlapping stages:
- Hemostasis: bleeding stops as a clot forms (minutes to hours).
- Inflammation: white blood cells clean the wound (about days 1 to 4).
- Proliferation: new tissue, blood vessels and skin form (days 4 to 21).
- Remodeling: the scar strengthens and matures (weeks to 2 years).
Disorders arise when a wound gets stuck in the inflammatory stage, as in chronic ulcers, or when remodeling overshoots, as in keloids.
Types of chronic wounds
| Type | Typical location | Clues |
|---|---|---|
| Diabetic foot ulcer | Soles, toes, pressure points | Often painless due to nerve damage; surrounded by callus |
| Venous ulcer | Inner lower leg above the ankle | Shallow, moist; swelling, brown skin, varicose veins |
| Arterial ulcer | Toes, heels, shin | Punched-out, painful, pale base; cold foot, weak pulses |
| Pressure injury | Sacrum, hips, heels | In people who are immobile; stages 1 to 4 |
| Surgical wound breakdown | Incisions | Opening, infection, fluid |
| Malignant wounds | Anywhere | Non-healing, irregular, growing; may be skin cancer |
Causes of poor wound healing
Local factors
- infection (wound infection) and bacterial biofilm
- poor blood supply from peripheral vascular disease
- venous hypertension and leg swelling
- pressure, friction and repeated trauma
- dead tissue or foreign material in the wound
- excess moisture or dryness
- previous radiation to the area
Body-wide factors
- diabetes, especially with high blood sugar
- malnutrition: low protein, vitamin C, zinc
- smoking
- older age
- obesity
- medicines: corticosteroids, chemotherapy, some immunosuppressants
- kidney and liver disease
- immune deficiencies
- anemia
Abnormal scarring
- Hypertrophic scars: raised, red scars that stay within the wound boundary and often improve over time.
- Keloids: scars that grow beyond the wound edges, are often itchy, and are more common in darker skin. Treated with steroid injections, silicone sheets, cryotherapy or surgery with additional treatment.
- Contractures: tight scars, often after burns, that limit movement.
Signs a wound is infected
- increasing pain, redness and warmth
- swelling
- pus or cloudy drainage
- bad smell
- red streaks spreading from the wound
- fever or chills
- wound getting larger or deeper
People with diabetes may have few signs, so any change needs checking.
Diagnosis
A clinician will measure and examine the wound, check pulses, sensation and swelling, and ask about health conditions, medicines and nutrition. Tests can include:
- ankle-brachial index and Doppler ultrasound for circulation
- wound swab or tissue culture
- X-ray or MRI for bone infection (osteomyelitis)
- blood sugar and HbA1c, blood count, albumin, kidney function
- biopsy of a wound that looks unusual or does not heal
Treatment
Treat the cause
- diabetes: blood sugar control and offloading pressure with special shoes or casts
- venous ulcers: compression bandages or stockings and leg elevation
- arterial ulcers: restore blood flow with angioplasty or bypass
- pressure injuries: frequent repositioning, pressure-relieving mattresses and cushions
- nutrition: adequate protein and calories; correct deficiencies
- stop smoking
Wound care
- clean with saline or clean water
- remove dead tissue (debridement)
- choose dressings that keep the wound moist but not wet
- treat infection with antibiotics when present
- advanced options: negative pressure wound therapy, skin grafts, cellular and tissue products, hyperbaric oxygen for selected diabetic foot ulcers
Prevention
- check feet daily if you have diabetes or neuropathy
- manage blood sugar, blood pressure and cholesterol
- wear compression stockings if prescribed for vein disease
- change position regularly if mobility is limited
- eat a balanced diet with enough protein
- do not smoke
Frequently asked questions
Why is my wound not healing?
Common reasons include infection, poor blood flow, diabetes, ongoing pressure or friction, leg swelling from vein problems, poor nutrition, smoking and medicines such as steroids. A wound that has not healed in 2 to 4 weeks should be assessed.
What is considered a chronic wound?
A chronic wound is one that has not healed within about 4 weeks, or has not made meaningful progress after 2 weeks of proper care. Common examples are diabetic foot ulcers, venous leg ulcers and pressure injuries.
How can I speed up wound healing?
Keep the wound clean and covered with an appropriate dressing, avoid pressure on it, control blood sugar, eat enough protein, stop smoking, raise swollen legs, and treat infection promptly. Address the underlying cause with your clinician.
What are signs of an infected wound?
Signs include increasing pain, redness, warmth and swelling, pus or cloudy fluid, a bad smell, red streaks spreading from the wound, and fever. Seek medical care promptly if these appear.
Sources
This guide was written from current patient and clinical guidance, including:
- Wound Healing Society: Guidelines for the treatment of chronic wounds
- American Diabetes Association: Standards of Care in Diabetes: Retinopathy, neuropathy, and foot care
- National Pressure Injury Advisory Panel: Pressure injury stages
- Society for Vascular Surgery and American Venous Forum: Venous leg ulcer guidelines
- MedlinePlus: Wounds and injuries
- NHS: Leg ulcers