Why is my foot sore not healing even though it doesn’t hurt?

Diabetic foot ulcers are often painless because of decreased feeling in the feet, and the usual warning signs are often absent because of nerve damage. Foot ulcers may take weeks or even several months to heal.

Start with what diabetes does to a foot. Diabetes can damage the nerves and blood vessels in your feet. This damage can cause numbness and reduced feeling in your feet. As a result, your feet are more likely to get injured and may not heal well if they are injured.

That is also why it may not hurt. Diabetic ulcers are often painless, because of decreased feeling in the feet. The same goes for warning signs: redness, warmth, or tenderness are things to look for on your feet, but they are often absent because of nerve damage.

So no pain tells you about the nerves, not about the wound. A foot sore that doesn’t hurt is typical, not reassuring. That’s the reason to check your feet every day, rather than only when you feel something.

There’s also a cause that has nothing to do with how the wound is dressed. Foot ulcers are partly caused by too much pressure on one part of your foot. A wound kept under pressure is being re-injured, which is why taking the weight off it is part of treatment, not an optional extra.

Healing takes longer than most people expect. It may take weeks or even several months for foot ulcers to heal. Slow is not the same as not healing.

One sign bears on this question directly: wounds that are pale, purple, or black are less likely to heal. Contact your provider if your foot ulcer is very white, blue, or black.

Infection matters too. Poor blood flow can slow healing, so an infection may last a long time. Sometimes, a bad infection never heals, and the infection might lead to gangrene.

One more point applies to any wound not healing as expected. Very rarely, a wound that doesn’t heal as expected may be due to another condition, including skin cancer or inflammatory diseases. A healthcare professional may suggest taking a small skin sample — a biopsy — to be sure of the diagnosis. This is a routine procedure that helps make sure you get the right treatment.

What to watch for

It may take weeks or even several months for foot ulcers to heal, so a wound healing slowly is not by itself a wound that has stopped healing.

Contact your provider for signs of infection — redness, increased warmth, or swelling around the wound; extra drainage; pus; odor; fever or chills; increased pain; or increased firmness — and if the ulcer is very white, blue, or black.

Call your provider right away for a cut, blister, or bruise on your foot that does not start to heal after a few days.

Check your feet every day, inspecting the tops, sides, soles, heels, and between your toes. Ask someone else to help if you can’t see well. This matters because redness, warmth and tenderness are often absent when there is nerve damage, so finding nothing that hurts is not the same as finding nothing.

Wound Wizard is general education and can’t assess your wound or your situation. Your own clinician is the right person to ask about your wound.

What we look at

  • Examining the ulcer and the whole foot
  • Checking sensation and the pulses in the foot
  • Identifying where pressure is falling on the foot
  • Assessing for infection and deciding whether further tests are needed

Sources

  1. Diabetes - foot ulcers — MedlinePlus, U.S. National Library of Medicine https://medlineplus.gov/ency/patientinstructions/000077.htm
  2. Diabetes and Foot Problems — National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/foot-problems
  3. Wound Q&A for patients and relatives — European Wound Management Association https://ewma.org/resources-for-patients-private-carers/wound-qa-for-patients-and-relatives/