Toes are the furthest point from the heart, and that shapes how they heal.
Ischemic ulcers — the wounds caused by poor arterial blood flow — may appear on the legs, ankles, toes, and between the toes. Here is what’s behind them: narrowed arteries prevent a healthy supply of blood from flowing to the legs, so tissues don’t get enough nutrients and oxygen. Cells die, and damaged tissue that doesn’t get enough blood flow tends to heal more slowly.
Between the toes matters for both ischemic and diabetic wounds, because it is the place least likely to be checked. Check the tops and bottoms of your feet, ankles, heels, and between the toes every day.
Two instructions apply specifically to toes and are easy to miss. On moisturizing: use lotion, petroleum jelly, lanolin, or oil on dry skin, but do not put lotion, oil, or cream between your toes unless your provider tells you to. And on nails: cut them straight across, because curved nails are more likely to become ingrown, and make sure the edge of each nail does not press into the skin of the next toe.
Footwear is the other toe-specific factor. Don’t wear shoes with pointed or open toes, such as high heels, flip-flops, or sandals. Wear shoes you can adjust with laces, Velcro or buckles, made of canvas, leather or suede.
Color carries its own instruction here. Contact your provider if a foot ulcer is very white, blue, or black. Wounds that are pale, purple, or black are less likely to heal.
And the general picture: infection, diabetes, poor circulation, nerve damage, bone infection, immobility, a weak immune system, poor nutrition, excess alcohol use, smoking, and a foreign body are reasons wounds fail to heal. A wound that has not started to heal in 2 weeks, or not completely healed in 6, is called non-healing.