The most important clinical threshold I ask every patient with diabetes to hold in their mind is two weeks. A diabetic foot wound that has not shown clear evidence of healing, meaning the wound is reducing in size, the surrounding redness is settling, and any discharge is reducing, within two weeks of appropriate wound care, needs surgical assessment. Not another week of dressings. Not a different dressing product. Surgical assessment. This threshold exists because diabetic foot wounds do not follow the same healing trajectory as wounds in a non-diabetic foot. Poor circulation means the wound base is not receiving the oxygen and nutrients that healing tissue requires. Nerve damage means you cannot rely on the symptom of pain to tell you whether the wound is improving or worsening. Beyond the two-week threshold, the specific signs that require urgent, same-day surgical assessment are: increasing redness, warmth, or swelling spreading away from the wound edge, indicating cellulitis; discharge that is cloudy, coloured, or has a foul odour; a wound that is visibly deep or in which you can see structures within the wound; fever or feeling generally unwell alongside the foot problem; or a wound that has recurred at the same location as a previous ulcer, which suggests an underlying structural or circulatory problem that has not been addressed.
At NiSH Clinic, 4th Block, Jayanagar, Bengaluru, I assess diabetic foot wounds with the same urgency as any other potentially limb-threatening surgical condition, and I would rather see a wound that turns out to be healing well than have a patient wait too long with one that is not.
Written by Dr. Niranjan P, MBBS, DNB General Surgery, Consultant General, GI, Laparoscopic, Robotic and Bariatric Surgeon, NiSH Clinic, 4th Block, Jayanagar, Bengaluru 560011. Phone: +91 9731174360.
