One explanation is not a setback at all. If dead tissue has recently been removed, the wound is expected to look larger. Afterward, the ulcer may seem bigger and deeper. It should be red or pink. Your wound may seem bigger and deeper after debridement. The area will be red or pink in color and look like fresh meat. A wound that grew at a visit where tissue was taken away is a different event from one that grew at home.
If that is not the explanation, pressure is the first thing to look at. Foot ulcers are partly caused by too much pressure on one part of your foot. And sometimes putting pressure on the healing ulcer for even a few minutes can reverse the healing that happened up to that point. If the special shoe, brace, cast, crutches or wheelchair is not being used every single time you are on your feet, that is where to look first — including the short trips.
Moisture is next. Keep your dressing and the skin around it dry. Try not to get healthy tissue around your ulcer too wet from your dressings. This can soften the healthy tissue and cause more foot problems. A wound can widen into skin that has been softened by being wet.
Infection belongs on the list too. A wound that is getting bigger along with redness, increased warmth or swelling, extra drainage, pus, odor, fever or chills, increased pain, or increased firmness around it is a wound to report, not to keep watching.
Then the slower factors. Keep your blood sugar level under good control. This helps you heal faster and helps your body fight infections. Infection, poor blood flow, smoking, heavy alcohol use, age and certain medicines — corticosteroids, NSAIDs and some chemotherapy medicines — can also slow wounds down.
There is also a benchmark to measure against. A wound is considered non-healing if it has not started to heal in 2 weeks or has not completely healed in 6 weeks.