Why Midfoot & Heel Wounds Are Dangerous
The midfoot and heel are weight-bearing structures with relatively thin soft-tissue coverage over bone. Wounds here track quickly to deeper structures, and patients with neuropathy often present late because they cannot feel the developing ulcer.
The Cornerstones of Care
- Offloading. Total contact casts, removable walkers, or specialty footwear redistribute weight away from the wound.
- Debridement. Removal of nonviable tissue at every visit.
- Infection control. Cultures, targeted antibiotics, and imaging when osteomyelitis is suspected.
- Vascular assessment. Arterial inflow must be adequate to heal.
When Surgery Is Needed
Surgical debridement, application of skin substitutes, or in advanced cases tendon balancing or bony procedures to eliminate the underlying pressure point.
Prevention
Daily inspection, moisture-balanced skin care, properly fitted shoes, and immediate evaluation of any blister or callus that opens.