Why Some Wounds Don’t Heal: Causes, Risks & When to See a Specialist

A small cut or scrape usually follows a predictable timeline: inflammation (first few days), new tissue formation (about 1–3 weeks), and gradual strengthening over the next several weeks. When a sore stays open, keeps draining, or gets worse instead of better, it may be a non-healing wound (often called a chronic wound). Chronic wounds aren’t just “slow”—they’re frequently a sign that something underneath (blood flow, infection, nerve damage, pressure, nutrition, or immune function) is blocking normal repair. Chronic leg and foot ulcers are commonly linked to chronic venous insufficiency, arterial disease, diabetes-related neuropathy, and prolonged pressure. PMC

This guide explains why wounds don’t heal, the most common slow wound healing reasons, who is at risk, what warning signs matter, and when to see a wound care specialist.

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What is considered a non-healing wound?

Clinically, a wound is often considered “non-healing” when it fails to make steady progress (shrinking, less drainage, healthier tissue) after a couple of weeks—or when it persists beyond the expected healing window and shows signs of chronic inflammation or poor blood supply. In venous leg ulcer guidance, lack of meaningful improvement over several weeks is a red flag that reassessment and escalation may be needed. EWMA

Common terms you’ll hear:

• Non-healing wounds / chronic wounds
• Wound healing problems / wound healing delay
• Slow healing wounds
• Chronic wound management / chronic wound care

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Why do some wounds not heal? The “root causes” (most common)

1) Poor circulation (arterial disease / PAD)

Wounds need oxygen and nutrients delivered by blood. If arteries are narrowed (often from peripheral artery disease), tissues may be starved of oxygen (ischemia), making wounds slow to close and more likely to become infected.

Clues it may be circulation-related:

• Wound on toes/foot edge
• Cool skin, weak pulses, leg pain with walking
• Black tissue (necrosis) or severe pain

Chronic wounds are strongly associated with vascular disease and arterial insufficiency. PMC

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2) Venous insufficiency (venous leg ulcers)

If leg veins don’t return blood effectively to the heart, pressure builds in the lower legs. This can damage skin, cause swelling, and lead to venous leg ulcers that heal slowly and often recur.

Clues it may be venous:

• Ulcer around the ankle/lower leg (often inner ankle)
• Swelling, heaviness, itchiness
• Brown discoloration/stasis skin changes

Venous disease is a major driver of chronic lower-extremity ulcers. PMC+1

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3) Diabetes (nerve damage + reduced blood flow)

Diabetes is one of the biggest reasons for chronic wound causes, especially diabetic foot ulcers. High blood sugar can damage nerves (so injuries go unnoticed) and reduce circulation, increasing infection risk and slowing repair. CDC+1

Clues it may be diabetic foot-related:

• Numbness/tingling
• Callus with a sore underneath
• Wound that “doesn’t hurt” but doesn’t heal

Diabetes-related foot infections can progress quickly and may lead to severe complications without prompt treatment. AAFP

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4) Infection (local infection or deeper involvement)

Even a small infection can stall healing by keeping the wound stuck in the inflammatory phase.

Signs of an infected wound:

• Increasing redness, warmth, swelling, pain
• Thick yellow/green drainage, foul odor
• Fever or chills
• Red streaks spreading from the wound

If infection is suspected—especially in diabetes—evaluation is important because infection can spread to deeper tissues or bone. AAFP

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5) Pressure and friction (pressure ulcers / “bedsores”)

Constant pressure reduces blood flow to skin—common on heels, tailbone, hips—leading to pressure ulcers. Reduced mobility, poor nutrition, and certain medical conditions increase risk. Evidence-based guidelines emphasize systematic prevention and treatment (offloading pressure, wound care, and addressing underlying factors). PMC

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6) Repeated trauma, poor wound care, or wrong dressing

A wound that’s continuously bumped, scratched, or exposed to irritants may never “graduate” from inflammation to repair. Using an inappropriate dressing (too dry, too wet, or changed too often/rarely) can also slow recovery.

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7) Nutrition problems and other health issues

Healing is a building project. The body needs enough:

• Protein (tissue building)
• Calories (energy for repair)
• Key micronutrients (like vitamin C, zinc—only supplement if a clinician recommends it)

Chronic wounds are also more common in older adults with multiple comorbidities and factors that impair microcirculation and inflammation control. ScienceDirect

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Who is at higher risk of chronic wounds?

You’re at higher risk of non-healing wounds if you have:

• Diabetes (especially with neuropathy) CDC+1
• Peripheral artery disease (PAD) or other circulation problems PMC
• Chronic venous insufficiency / varicose veins jvascsurg.org
• Limited mobility or long periods in bed/wheelchair (pressure ulcers) PMC
• Smoking, kidney disease, immune suppression, poor nutrition
• Prior ulcers (recurrence is common) PMC

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How to tell if a wound is healing properly vs. becoming chronic

Signs of normal healing

• Gradually shrinking size
• Less drainage and swelling
• Pink/red healthy “granulation” tissue
• Less pain over time

Red flags (wound healing problems)

• No improvement after 1–2 weeks
• Wound getting larger or deeper
• Increasing drainage, odor, or pain
• Black tissue, pale/gray tissue, or exposed tendon/bone
• New numbness (especially in feet)

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When should I see a doctor for a wound? When to see a wound care specialist?

Seek medical evaluation promptly if:

• The wound is not improving after ~2 weeks
• You have diabetes, poor circulation, or immune suppression
• There are signs of infection (spreading redness, fever, pus, worsening pain)
• The wound is on the foot, especially with diabetes
• You can’t feel the area (possible neuropathy)

See a wound care specialist / wound care clinic if:

• You have a suspected venous leg ulcer, arterial ulcer, pressure ulcer, or diabetic foot ulcer
• You’ve had repeated ulcers or slow healing despite basic care
• You may need advanced therapies (debridement, offloading, compression, vascular evaluation)

For diabetic foot problems, guidelines emphasize rapid referral to specialist multidisciplinary foot services when an active diabetic foot problem is identified. NICE+1

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What do specialists do differently? Chronic wound treatment options

A specialist’s first priority is to treat the cause, not just the surface.

1) Full wound assessment

• Size, depth, drainage, odor, surrounding skin
• Vascular assessment (circulation testing when needed)
• Infection assessment (sometimes culture; imaging if bone infection suspected)

2) Debridement (removing dead tissue)

Removing non-viable tissue can “reset” the wound bed so healthy tissue can grow.

3) Offloading (especially for diabetic foot ulcers)

Offloading reduces pressure on the ulcer. Total contact casting (TCC) is a well-studied approach in diabetic foot care and is associated with higher healing rates compared with some conventional approaches when appropriately used. PMC

4) Compression therapy (for venous ulcers)

Compression is a cornerstone for venous leg ulcers because it addresses venous hypertension (the root mechanism). jvascsurg.org+1

5) Advanced wound care therapies (when appropriate)

Depending on the wound type and cause, a clinic may use:

• Negative pressure wound therapy (NPWT)
• Certain skin substitutes/engineered tissue products
• Growth-factor or matrix-based products (selected cases)

Chronic wound care has evolved into a specialty using advanced therapies for selected patients. PMC+1

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Practical home-care basics (safe, general tips)

These don’t replace medical care for chronic wounds—but they help support healing:

• Keep it clean: gentle cleansing; avoid harsh antiseptics unless directed.
• Moist wound healing: many wounds heal best in a controlled moist environment (right dressing type matters).
• Protect from pressure/friction: don’t keep reopening the same spot.
• Control blood sugar if diabetic (key for infection risk and healing). CDC
• Don’t smoke (smoking impairs circulation and oxygen delivery).
• Seek help early if worsening, painful, or infected.

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