Why Diabetic Foot Wounds Won’t Heal—and How PAD Plays a Role

For millions of people living with diabetes, checking their feet is a daily ritual. It’s a necessary precaution because a small cut, blister, or crack in the skin can quickly turn into a major health crisis. When these injuries refuse to heal, they become diabetic foot ulcers—a condition that affects approximately 15% of diabetic patients in their lifetime.

While high blood sugar levels are often blamed for these complications, there is another silent partner in this process that is frequently overlooked: Peripheral Arterial Disease (PAD).

PAD is a circulatory condition that narrows the arteries and restricts blood flow to the legs and feet. When combined with diabetes, it creates a “perfect storm” that prevents wounds from healing and significantly raises the risk of amputation. At Fox Vein and Vascular in Manhattan, Dr. David Fox specializes in treating the vascular underlying causes of non-healing wounds to save limbs and restore quality of life.

The Diabetes-Circulation Connection

Diabetes affects the body in multiple ways, but two of its most damaging effects are on the nerves and the blood vessels.

1. Neuropathy (Nerve Damage): High blood sugar levels over time can damage the nerves in the feet, leading to a loss of sensation. This means a diabetic patient might step on a tack, wear shoes that are too tight, or develop a blister without ever feeling pain. This loss of feeling allows minor injuries to go unnoticed until they have become significant wounds.
2. Vasculopathy (Blood Vessel Damage): Diabetes accelerates the buildup of plaque in the arteries (atherosclerosis), causing them to narrow and harden. This is the mechanism behind PAD. When arteries are blocked, they cannot deliver enough oxygen-rich blood to the feet.

It is this second factor—the lack of blood flow—that turns a simple injury into a chronic, non-healing wound.

Why Won’t the Wound Heal?

Healing is an energy-intensive process. When you sustain an injury, your body needs to rush extra supplies to the site: oxygen to fuel cell growth, nutrients to rebuild tissue, and white blood cells to fight off bacteria.

In a patient with PAD, the “roads” (arteries) delivering these supplies are blocked.

• Oxygen Starvation: Without enough oxygen, the tissue cannot regenerate. The wound stays open, or worse, the tissue begins to die (gangrene).
• Weakened Defense: The immune system relies on the bloodstream to deliver infection-fighting cells. If circulation is poor, the wound is left defenseless against bacteria.
• Infection Risk: A diabetic foot ulcer/wound is rich in sugar (due to high blood glucose), making it an ideal breeding ground for bacteria. Combined with a weak immune response due to poor flow, infections can spread rapidly to the bone (osteomyelitis) or bloodstream (sepsis).

This is why a non-healing wound/ulcer of toe, leg, foot is a major red flag. It is not just a skin issue; it is a sign that the limb is not getting enough blood to survive.

Recognizing the Signs of PAD in Diabetic Patients

Because neuropathy can mask pain, diabetic patients may not feel the classic PAD symptoms like leg cramping (claudication). Therefore, it is critical to look for other visual and physical signs of poor circulation:

• Cold Feet: One foot may feel significantly cooler than the other or cooler than the rest of the leg.
• Skin Changes: The skin on the legs may appear shiny, thin, or hairless. The toes may look pale when elevated and red when hanging down.
• Slow Growth: Toenails may grow slowly or become brittle.
• Wound Characteristics: Diabetic ulcers related to PAD often appear on the toes, heels, or pressure points. They may look “punched out” with well-defined borders and a pale or black base.

If you notice any of these signs, seeing a vascular specialist immediately is crucial. Waiting for the wound to heal on its own is a gamble that can lead to limb loss.

The Role of the Vascular Specialist in Amputation Prevention

Standard wound care—cleaning, dressing, and offloading pressure—is essential, but it is not enough if the blood flow is blocked. You cannot heal a wound on a starving limb. This is where Dr. Fox and the team at Fox Vein and Vascular intervene.

Our primary goal is amputation prevention through revascularization. By restoring blood flow to the foot, we give the body the fuel it needs to heal the ulcer.

Diagnosis

We start with comprehensive non-invasive testing in our vascular lab, including Ankle-Brachial Index (ABI) measurements and Duplex Ultrasound. These tests allow us to map the arteries and pinpoint the exact location and severity of the blockages.

Minimally Invasive Treatment

Dr. Fox specializes in modern, outpatient PAD treatment options that avoid major surgery.

• Angioplasty: A small balloon is used to open narrowed arteries.
• Atherectomy: Plaque is removed from the artery walls to restore a clear path for blood flow.
• Stenting: A mesh tube is placed to keep the artery open.

These procedures are often performed through a tiny puncture in the groin or wrist. Recovery is quick, and the improvement in blood flow is immediate. Learn more about our minimally invasive vascular procedures Manhattan patients trust.

A Team Approach to Healing

Treating diabetic foot wounds requires a team effort. While Dr. Fox focuses on restoring circulation, we work closely with podiatrists, primary care physicians, and wound care specialists to ensure every aspect of the patient’s health is addressed.

• Vascular Care: Opens the arteries to allow healing.
• Podiatry/Wound Care: Manages the wound environment and relieves pressure.
• Endocrinology/Primary Care: Manages blood sugar levels to prevent further damage.

This multidisciplinary approach offers the highest chance of healing the wound and saving the limb.

Don’t Ignore a Non-Healing Wound

If you have diabetes and a sore on your foot that hasn’t healed in two weeks, consider it an emergency. The window for effective intervention can close quickly. Early evaluation by a vascular surgeon in Manhattan can mean the difference between walking on two feet and facing an amputation.

At Fox Vein and Vascular, we are dedicated to limb salvage. We serve patients from the 5 Boroughs, Nassau, Suffolk, South Western CT, and North East NJ.

Take the first step toward healing. Contact us today to schedule your evaluation.

Fox Vein and Vascular – Manhattan, NY
📞 (212) 362-3470
🌐 foxvein.com