Non-healing Wounds

    Toe with a non-healing wound

    During a person’s lifetime some will experience wounds that take a little longer to heal. For people with chronic and persistent wounds that do not show signs of improvement, this may signify venous or arterial disease.1 Non-healing wounds, are chronic sores or ulcers on the toes, feet, or legs that aren’t healing well.1,2 These sores can cause pain, odor and oozing pus from their openings, making it difficult to walk and function normally. Because these sores will not heal on their own, it is very important to seek immediate help from your doctor.

    Symptom Details


    People with peripheral vascular disease (PVD) may start out with mild symptoms, or no symptoms. Without treatment, conditions such as varicose veins, tired heavy legs and pain at rest can eventually turn into more severe complications as the disease progresses.


    More than 500,000 to 2 million people in the United States suffer from leg ulcers, or non-healing wounds.8 Conditions such as superficial venous insufficiency (SVI) and deep venous disease (DVD) can reduce blood flow to the extremities and can make it difficult for the body to heal itself. These sores usually develop on the leg above the ankle.2


    Arterial disease such as critical limb ischemia (CLI) can also cause wounds to heal slowly. This advanced form of arterial disease can result in ulcers below the ankle as well as kissing ulcers, or non-healing wounds between toes.


    Non-healing wounds are almost always accompanied by redness, swelling and pain. Left untreated, these sores are at risk of developing an infection, which can lead to serious, long-term health complications, including amputation of the limb.3


    Symptoms can range depending on the progression of the underlying PVD disease and how far it has progressed.4,5,6 If you are experiencing any of these symptoms consistently, it is important to take the step and seek help from your doctor right away.

    Venous Causes and Symptoms


    More than 80 percent of leg ulcers are caused by venous disease.9 When the veins in your legs are not working efficiently to carry blood back to the heart, the valves have become damaged and blood flows the wrong way. This back-up of fluid causes blood to pool in the leg and builds increased pressure on the vein walls. This condition can lead to skin damage and non-healing wounds.


    Venous wounds develop above the ankle when the blood pools in the ankles. The leaky veins result in pooling of inflammatory substances in the blood, which in turn irritate the skin chronically and lead to wounds.


    • The skin may thicken and become hard
    • Changes in color, usually black or dark bluish color, around the wound area
    • Swelling and redness may develop
    • Fluid may discharge from the wound
    • A foul-smelling odor may happen

    Arterial Causes and Symptoms


    Arterial disease can also cause non-healing wounds. As fatty plaque builds up inside the artery, it narrows and restricts blood flow to the limbs. This damage to blood vessels can result in non-healing wounds.


    • Legs that feel fatigued
    • Pain in the affected limb may be felt while sleeping or resting
    • Persistent and increasing pain around the wound area
    • Skin may be cool to touch and hairless
    • Gangrene, or black toe, may also occur

    Risk Factors

    Foot with non healing wound factor icon

    Not all people with PVD disease will develop non-healing wounds. But there are certain risk factors that can increase the chances of developing the severe condition.


    These risks include:7,8


    • Obesity or being overweight can put pressure on your legs and restrict healthy blood flow. Over time skin damage and leg sores may occur
    • Certain medical conditions such as high cholesterol, high blood pressure and diabetes can increase the likelihood of developing non-healing wounds
    • Smoking can damage the veins and their ability to transport blood
    • History of varicose veins can predispose you to developing these types of sores
    • Being older than 60 can increase the likelihood of developing arterial or venous disease

    What to Look For


    Non-healing wounds usually do not begin on their own. A person may notice swelling, varicose veins, or many other symptoms relating to PVD disease. As the condition advances open sores can develop.

    Arterial Signs

    The Rutherford Classification is a common system that is widely used to diagnose and identify the severity of arterial disease as it progresses.

    Rutherford Classification10

    Stage 0

    Stage 1

    Stage 2

    Stage 3

    Stage 4

    Stage 5

    Stage 6

    No symptoms

    Some exercise pain after walking long distances

    Exercise pain that occurs more frequently at shorter distances

    Severe exercise pain that happens frequently after a short distance

    Pain in the legs, calves, buttocks that occurs despite rest

    Leg ulcers begin to develop

    Severe non‑healing wounds can lead to gangrene or tissue loss

    Arterial Ulcer

    Arterial Ulcer

    Venous Signs

    Non-healing venous wounds, caused by Venous Disease, may present these signs


    • Thick, lumpy skin near the sore
    • Redness or discoloration around the area can develop
    • Swelling in the leg may occur and worsen as the day progresses
    • Ankles may be swollen
    • White colored scarring near the sore
    • Varicose veins may also be present

    Venous Ulcer

    Venous Ulcer

    When to See a Doctor


    If you have a wound that persists and fails to improve, it is crucial to take the step and seek help. These wounds will not heal on their own without medical treatment. It is important to get properly diagnosed, especially to reduce the risk of infection and long-term complications.


    Talk to your doctor, or use our tool to locate a doctor to consult for a diagnosis..

    Helpful Resources

    Checklist icon

    PVD Doctor
    Discussion Guide


    Get helpful tips and advice on how to talk to your doctor about a PVD screening.

    Third-Party Resources



    A mobile app built by cardiologists, to simplify understanding of most cardiac and peripheral vascular conditions and treatments.

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    1. Iqbal et al. “Management of Chronic Non-healing Wounds by Hirudotherapy.” World Journal of Plastic Surgery. 2017 Jan; 6(1): 9–17.

    2. Hess, Thomas. “Checklist for Factors Affecting Wound Healing.” Advances in Skin & Wound Care: April 2011 – Volume 24 – Issue 4 – p 192.

    3. Guo et al. “Factors Affecting Wound Healing.” J Dent Res. 2010 Mar; 89(3): 219–229.

    4. Frykberg et al. “Challenges in the Treatment of Chronic Wounds.” Adv Wound Care (New Rochelle). 2015 Sep 1; 4(9): 560–582.

    5. “6 Signs You Have an Infected Wound.” Advanced Tissue. n.d.

    6. Walshe C. “Living with a venous leg ulcer: a descriptive study of patients’ experiences.” J Adv Nurs. 1995 Dec;22(6):1092-100.

    7. Grey et al. “Venous and arterial leg ulcers.” BMJ. 2006 Feb 11; 332(7537): 347–350.

    8. Margolis DJ, Bilker W, Santanna J, et al. “Venous leg ulcer: incidence and prevalence in the elderly.” J Am Acad Dermatol 2002;46(3):381-6. PMID: 11862173

    9. Simon et al. “Management of venous leg ulcers.” BMJ. 2004 Jun 5; 328(7452): 1358–1362.

    10. Hardman et al. “Overview of Classification Systems in Peripheral Artery Disease.” Semin Intervent Radiol. 2014 Dec; 31(4): 378–388.



    The opinions and clinical experiences presented herein are for informational purposes only. Individual results may vary depending on a variety of patient-specific attributes and related factors. Dr. Raghu Kolluri has been compensated by Philips for his services in preparing and providing this material for Philips further use and distribution.


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