Wound Care and Dressings

A wound on the foot or lower leg needs more than a dressing. Wound care in Australia is guided by the Australian Standards for Wound Prevention and Management, now in their fourth edition (2023).¹ Good wound care looks at the wound itself (such as its size and depth), at what is keeping it open, and at the person as a whole, including blood supply, feeling in the foot, pressure and general health.² This matters most for people living with diabetes, where a small break in the skin can become serious quickly, and where care usually involves a team rather than a single clinician working alone.^2,4

Care usually has four parts. First, we check the blood supply and any signs of infection, because both shape what is safe and what is needed next.^2,4 Second, we clean the wound and carefully reduce the thick callus around it where that is appropriate. Removing dead tissue (sharp debridement) is referred to your GP or a surgeon. Third, we take pressure off the wound (offloading) with padding, dressing choices and advice on footwear and activity. For a diabetes-related ulcer on the sole of the foot, the Australian offloading guideline recommends a knee-high device that cannot be removed as the first choice, with removable knee-high devices, ankle-high devices and medical-grade footwear as other options when the first is not suitable.³ We do not fit non-removable knee-high devices or supply medical-grade footwear here. If your foot is high risk and needs one of those, that is a referral: we write to your GP and refer you to a high risk foot clinic at a tertiary hospital, and keep working alongside them. Fourth, we choose a dressing to suit the wound, mainly its moisture, drainage and infection risk, and change it as the wound changes. A dressing supports the wound but does not replace treating the cause.

For most people, wound care involves regular short visits, a plan for what to do between visits, and clear advice on warning signs. Any new ulcer, blister, unusual swelling or redness on the foot should be looked at the same day by a health professional, particularly if you have diabetes or reduced feeling in your feet.⁵ Contact your GP promptly if a wound is not improving, has more drainage or smell, or the skin around it is getting redder, hotter or more swollen.⁴ Go to an emergency department, or call 000, if you have spreading redness with fever or feeling very unwell, black or dead-looking tissue, or a foot that is cold, pale or severely painful.^2,4 We work with your GP, diabetes team, vascular surgeons and the high risk foot services at the tertiary hospitals, and will refer you on quickly when a wound is beyond what can be safely managed in a clinic.^2,4