Why is the wound on my shin not healing?

Written by WISH Clinic

Clinically reviewed by Dr. Traci A. Kimball, MD, MBA

Last medical review

A wound is non-healing if it hasn’t started to heal in 2 weeks or fully healed in 6. Causes include infection, diabetes, poor blood flow, obesity, age, alcohol, stress, some medicines, smoking, nerve damage, bone infection, immobility, poor nutrition, or something left in the wound.

There’s no healing advice just for the shin. It isn’t one of the bony spots where pressure sores usually form. Venous ulcers usually form above the ankle, and ulcers from poor blood flow show up on legs, ankles, toes and between toes. So the answer comes from how wounds heal in general, and there’s a lot to say about that.

Start with the benchmark, because it turns a worry into a date. A wound is called non-healing if it has not started to heal in 2 weeks or has not completely healed in 6 weeks. Work out which side of those marks your wound is on before anything else.

Then the reasons. Several things can prevent wounds from healing or slow the process: infection, which can make a wound larger and take longer to heal; diabetes; poor blood flow due to clogged arteries (arteriosclerosis) or conditions such as varicose veins; obesity; age, since older adults heal more slowly than younger people; heavy alcohol use; stress; medicines, including corticosteroids, NSAIDs and some chemotherapy medicines; and smoking.

Other factors include nerve damage, bone infection, being inactive or immobile, a weak immune system, poor nutrition, and having a foreign body (such as a piece of wood or broken glass) in the wound. That last one is worth a moment on a shin in particular. If the wound started with a knock against something, say so, because it changes what gets looked for.

One question about the leg is worth settling rather than assuming: whether there is a circulation problem behind this wound. A venous leg and a leg with poor arterial flow need opposite things, and the treatment for one is a warning for the other. That is its own question, and it is the first thing to establish about any leg wound that is not healing.

A wound care team will examine and measure your wound, check the blood flow in the area around the wound, determine why it’s not healing, and create a treatment plan. To be honest about what follows: non-healing wounds may take months to heal. Surgery may be performed to speed up healing. Some wounds never heal completely.

What to watch for

Contact your provider right away if you have redness, increased pain, or yellow or green pus, or excessive clear fluid around the injury; black edges around the injury, which is a sign of dead tissue; bleeding that will not stop after 10 minutes of direct pressure; fever of 100°F (37.7°C) or higher for more than 4 hours; pain at the wound that will not go away, even after taking pain medicine; or a wound that has come open or the stitches or staples have come out too soon.

Take two things to the appointment. The date the wound started, so the 2-week and 6-week marks can be applied rather than guessed at. And an honest run through the list of factors above — smoking, alcohol, nutrition and medicines included — because those are the parts nobody can see and the parts most likely to change the outcome.

What we look at

  • Whether the 2-week or 6-week non-healing marks have passed
  • Whether blood flow to the leg has been assessed
  • Whether a foreign body may remain, if the wound began with an impact
  • Which of the listed healing factors apply to this patient
  • Whether the wound has been measured and recorded over time

Related questions

Sources

  1. MedlinePlus — How wounds heal: https://medlineplus.gov/ency/patientinstructions/000741.htm
  2. MedlinePlus — Wound care centers: https://medlineplus.gov/ency/patientinstructions/000739.htm
  3. MedlinePlus — Venous ulcers, self-care: https://medlineplus.gov/ency/patientinstructions/000744.htm
  4. MedlinePlus — Ischemic ulcers, self-care: https://medlineplus.gov/ency/patientinstructions/000742.htm
Non-healing wound care at The WISH Clinic

The Wish Clinic®

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