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Peripheral Artery Disease Leg Ulcer Treatment at Home in Greater Noida: A Post-Angioplasty Case Study

Peripheral Artery Disease with Non-Healing Leg Ulcer: Home Healthcare Case Study | Greater Noida
Home Patient Care Case Study: PAD with Leg Ulcer
Clinical Case Study Greater Noida

Recovery from Peripheral Artery Disease with a Non-Healing Leg Ulcer Through Coordinated Home Healthcare

A 73-year-old retired consultant from Greater Noida underwent peripheral angioplasty for a chronic non-healing ankle ulcer. This case study documents how structured home nursing, physiotherapy, and caregiver support over eight weeks promoted wound healing, restored mobility, and prevented hospital readmission.

Age

73 Years

Gender

Male

Location

Greater Noida

Primary Condition

PAD with Leg Ulcer

Duration of Care

8 Weeks

Hospital Stay

8 Days

Procedure

Angioplasty + Stent

Outcome

Wound Healing

Patient Background

Mr. Devendra Chauhan is a 73-year-old retired industrial consultant living in Greater Noida, Uttar Pradesh. He lives with his wife, who is 69 years old and serves as his primary caregiver. His son resides in the same city and provides secondary support, including help with hospital visits and logistics.

He has been living with Type 2 Diabetes Mellitus for 16 years. Over time, he also developed hypertension, elevated cholesterol levels, and known coronary artery disease. He was a smoker for many years but quit six years ago after his cardiac diagnosis. Despite quitting, the cumulative vascular damage from smoking and long-standing diabetes had already begun affecting his peripheral circulation.

Before this episode, Mr. Chauhan was independent in most daily activities. He could walk within his home and nearby areas without difficulty. His baseline functional status was reasonable for his age, though his endurance had been gradually declining over the preceding months due to leg discomfort while walking, a symptom he had initially attributed to aging.

Identified Risk Factors for Delayed Wound Healing

  • Type 2 Diabetes Mellitus of 16 years duration, impairing microvascular circulation and collagen formation
  • History of smoking causing endothelial damage and reduced collateral blood vessel formation
  • Hypertension contributing to further arterial wall stiffness
  • Hyperlipidemia accelerating atherosclerotic plaque buildup in peripheral arteries
  • Age-related reduction in tissue regeneration capacity

Clinical Diagnosis

Primary Diagnosis

Peripheral Artery Disease (PAD) with Chronic Non-Healing Leg Ulcer, Left Lower Limb

Clinical Findings at Presentation

Mr. Chauhan presented with complaints of pain in the left leg that worsened with walking, a wound near the left ankle that had been slowly healing over several weeks, and visible swelling of the lower leg. The pain pattern was consistent with claudication, a classic symptom of peripheral arterial insufficiency where muscles do not receive enough blood flow during activity.

Vascular investigations, including Doppler ultrasound studies, confirmed significant narrowing of the arterial supply to the left lower limb. The reduced blood flow explained why the ankle ulcer was not progressing through the normal phases of wound healing despite basic care. Tissue repair requires adequate oxygen and nutrient delivery, both of which were compromised by the arterial blockage.

Vital Signs at Discharge

ParameterValueReference RangeAssessment
Blood Pressure132/80 mmHgBelow 140/90 mmHgControlled
Heart Rate76 bpm60-100 bpmNormal
Respiratory Rate18/min12-20/minNormal
Temperature98.4°F97-99°FNormal
Oxygen Saturation98% on room air95-100%Normal

Wound Assessment at Discharge

Wound ParameterFinding
LocationLeft medial ankle
Wound Size3.5 cm × 2.8 cm
Tissue TypeHealthy granulation tissue present
DischargeMild serous discharge
OdourNo foul odour
Periwound SkinHealthy, no maceration or erythema
Peripheral PulsesImproved after angioplasty

Functional Assessment at Discharge

Mobility Status

  • Ambulating with a walking stick
  • Walking tolerance: 120 metres
  • Requires periodic rest during longer walks
  • Mild pain while walking

Activities of Daily Living

  • Requires help: Wound dressing, outdoor mobility, shopping, medication reminders, hospital visits
  • Independent: Feeding, bathing, dressing, communication

Hospital Treatment

Mr. Chauhan was admitted to a multi-specialty hospital in the Noida-Greater Noida corridor for evaluation and management of his worsening leg condition. The hospital stay lasted eight days, during which the vascular surgery team performed a thorough assessment and planned an endovascular intervention.

The decision to proceed with angioplasty was based on the confirmed arterial narrowing on imaging and the fact that the ulcer was not healing because of inadequate blood supply. Simply continuing wound care without restoring blood flow would have had limited benefit. The angioplasty successfully opened the blocked segment, and a stent was placed to keep the artery open.

During the hospital stay, the medical team also focused on optimizing his blood sugar levels, which is critical because hyperglycemia directly impairs wound healing by reducing white blood cell function and slowing collagen synthesis. Intravenous antibiotics were administered to prevent any wound infection from progressing. Pain management was adjusted to allow early mobilization.

Hospital Course Summary

  • 1.Peripheral angioplasty with stent placement to restore arterial blood flow to the left lower limb
  • 2.Intravenous antibiotics to address and prevent wound infection
  • 3.Advanced wound dressing initiated under surgical supervision
  • 4.Pain management optimized to support early ambulation
  • 5.Blood sugar optimization through adjusted insulin or oral medication protocol
  • 6.Vascular surgery consultation for post-procedure monitoring and discharge planning

Why Home Healthcare Was Needed

After eight days in the hospital, Mr. Chauhan was medically stable for discharge. His vital signs were within acceptable limits, the angioplasty had restored blood flow, and the wound was showing early signs of healthy granulation. However, the ulcer was far from healed. At 3.5 cm by 2.8 cm, it still required daily sterile dressing, regular measurement, and close infection surveillance.

The treating vascular team recommended continued wound care at home rather than extending the hospital stay. This is a well-established approach in vascular surgery. Once the underlying blood flow issue has been corrected and the patient is hemodynamically stable, the wound healing phase can safely be managed in a home setting with professional nursing support. Prolonged hospital stays, in fact, carry their own risks including hospital-acquired infections, deconditioning from reduced physical activity, and psychological distress in elderly patients.

Several specific factors made professional home nursing clinically appropriate in this case. The wound required sterile technique for dressing changes, which the patient’s wife, at 69 years old, could not be expected to perform independently. The patient had diabetes, meaning any lapse in wound care or blood sugar monitoring could rapidly lead to infection or delayed healing. He also needed structured physiotherapy to rebuild his walking endurance safely, which required supervised sessions rather than unsupervised exercise at home.

In Greater Noida, families sometimes rely on untrained domestic helpers for post-discharge care. As documented in cases across the Delhi NCR region, relying on untrained home help for clinical wound care carries significant risk. A person without medical training cannot assess wound bed status, recognize early signs of infection, or monitor for vascular complications. For a patient with PAD and diabetes, such gaps in care can lead to rapid deterioration and potential limb-threatening outcomes.

Clinical Reasoning

“The angioplasty restored the plumbing. But the wound still needed weeks of careful dressing, the leg needed supervised rehabilitation, and the diabetes needed daily monitoring. Sending this patient home without professional nursing support would have meant relying on a 69-year-old spouse to perform sterile wound procedures and recognize signs of re-occlusion or infection. That is not safe discharge planning. Home healthcare bridged the gap between hospital stability and full recovery.”

Home Care Plan by AtHomeCare

Home Nursing

Daily visits during the first two weeks, then tapered based on wound progress

A qualified nurse visited Mr. Chauhan’s home every day for the first two weeks. The primary responsibility was performing sterile wound dressing changes. In a patient with diabetes and a recently vascularized limb, the wound dressing is not simply about covering the area. It involves cleaning the wound bed with appropriate solutions, assessing the type and amount of discharge, checking for signs of infection such as increased redness, warmth, swelling, or purulent discharge, and documenting the wound dimensions at each visit to track healing trajectory.

Beyond wound care, the nurse monitored blood pressure and blood sugar levels daily. This was important because blood sugar directly affects wound healing. Persistent hyperglycemia impairs the function of fibroblasts and white blood cells, slowing granulation tissue formation and increasing infection susceptibility. By tracking blood sugar at home, any upward trend could be communicated to the treating physician before it impacted the wound.

The nurse also supervised medication administration. Mr. Chauhan was prescribed antiplatelet medication to prevent stent thrombosis, cholesterol-lowering medication to slow atherosclerosis progression, and his regular diabetes and blood pressure medications. Ensuring adherence to this regimen was critical, especially the antiplatelet therapy, because missing doses after a recent stent placement carries a risk of acute re-occlusion.

Physiotherapy at Home

Four sessions per week, supervised and progressive

Physiotherapy at home was introduced to address Mr. Chauhan’s reduced walking endurance and to support circulation in the affected limb. After weeks of limited walking due to pain, his calf muscles had weakened, and his overall stamina had declined. Structured rehabilitation was necessary to reverse this deconditioning safely.

The physiotherapy program included supervised walking drills starting at distances shorter than his 120-metre tolerance and gradually increasing. Ankle mobility exercises were prescribed to maintain joint range of motion, which can become stiff when a person reduces walking due to pain. Lower limb strengthening exercises targeted the calf and thigh muscles to improve venous return and provide better support during walking.

Balance training was included because elderly patients with reduced walking confidence are at a higher fall risk. A fall onto the affected leg could traumatize the healing wound or, in a worst case, disrupt the stent. The physiotherapist also taught circulation-enhancing exercises that the patient could perform independently while sitting, promoting blood flow to the lower limb without placing weight on the healing ankle.

Patient Attendant

8-hour daytime support through a trained patient care attendant

A trained patient attendant was assigned for eight hours during the daytime. The role of the attendant was distinct from the nurse. While the nurse handled clinical procedures, the attendant provided the continuous presence that a recovering elderly patient needs during the day.

The attendant supervised Mr. Chauhan’s walking within the home, ensured he took his meals on time, reminded him about medication between nurse visits, and assisted with leg elevation. Elevating the affected leg periodically helps reduce swelling by promoting venous and lymphatic drainage. After angioplasty, some degree of leg swelling is common and managing it supports wound healing by reducing tissue tension around the ulcer.

The attendant also served as an extra set of eyes for any change in the patient’s condition. If Mr. Chauhan reported increased pain, if the wound dressing appeared displaced, or if he seemed unwell, the attendant could immediately inform the family and the nursing team. This layer of patient care services is especially important when the primary caregiver is also elderly and may not be able to provide continuous supervision.

Medical Equipment at Home

Arranged through medical equipment rental and existing home supplies

Digital Blood Pressure Monitor

Glucometer

Pulse Oximeter

Walking Stick

Sterile Wound Dressing Kit

Medication Organizer

Compression Therapy (only if prescribed by the vascular specialist)

Daily Recovery Plan

Morning

  • Vital signs recording
  • Fasting and post-meal blood sugar monitoring
  • Morning medication administration
  • Wound inspection by nurse
  • Light breakfast
  • Supervised walk with attendant

Afternoon

  • Physiotherapy session
  • Rest with leg elevation
  • Midday meal
  • Adequate hydration monitoring
  • Medication reminder

Evening

  • Dressing review if required
  • Evening medication
  • Gentle walking within home
  • Skin assessment of both legs
  • Leg elevation before sleep

Risks Being Actively Monitored

Wound Infection

Daily assessment for increased redness, warmth, purulent discharge, or systemic fever signs

Delayed Wound Healing

Weekly wound measurements to confirm progressive reduction in size

Reduced Blood Circulation

Monitoring for return of claudication pain, coldness of the limb, or colour changes in the foot

Blood Sugar Fluctuations

Daily fasting and post-prandial readings to ensure glycemic control supports wound repair

Falls

Walking supervision, balance training, and home hazard assessment

Recurrent Vascular Blockage

Watching for sudden return of severe pain or limb pallor that could indicate stent thrombosis

Hospital Readmission

Early identification of any deterioration to enable timely medical intervention before emergency hospital transfer becomes necessary

Recovery Timeline

D1

Day 1: Transition from Hospital to Home

Mr. Chauhan arrived home from the hospital in the afternoon. The first home nursing visit was scheduled for the same evening. The nurse assessed the wound, confirmed the dressing from the hospital was intact, and recorded baseline vital signs and blood sugar at the home setting. The patient reported mild pain in the left leg and some anxiety about managing at home. His wife appeared tired from the hospital visit. The attendant was introduced and oriented to the daily routine, medication schedule, and emergency contact numbers.

Wound assessed Vitals recorded Attendant oriented
D3

Day 3: First Wound Dressing Change at Home

The nurse performed the first full sterile dressing change at home. The wound bed was assessed in detail. Granulation tissue appeared healthy with no signs of infection. Wound dimensions were measured and documented as 3.5 cm by 2.8 cm, consistent with the discharge summary. Blood sugar levels were slightly elevated on one reading, which was communicated to the family with advice on dietary adjustments. The patient walked a short distance within the home with the attendant’s support and reported that the pain was less than before the angioplasty.

Granulation healthy Blood sugar slightly elevated Pain reduced
W1

Week 1: Establishing Routine

By the end of the first week, a daily rhythm had been established. Morning vitals, wound care, medication, physiotherapy sessions, and evening reviews were happening consistently. Blood sugar readings stabilized after the initial dietary adjustment. The wound showed no signs of infection. Mr. Chauhan was walking up to 150 metres with his stick, a slight improvement from his 120-metre baseline. He reported feeling more confident at home. The first doctor home visit was conducted to review overall progress.

Walking 150m No infection Blood sugar stable
W2

Week 2: Measurable Wound Reduction

The wound measurement at the end of week two showed a reduction to approximately 2.8 cm by 2.2 cm. This was an encouraging sign that the restored blood flow, combined with consistent wound care and glycemic control, was supporting tissue repair. The serous discharge had decreased. The nursing frequency was discussed with the treating doctor and it was decided to reduce visits to every alternate day while continuing daily monitoring through the attendant. Physiotherapy sessions continued at four per week. Mr. Chauhan was now walking 200 to 220 metres with rest breaks.

Wound: 2.8 x 2.2 cm Walking 200-220m Nursing reduced to alternate days
W4

Week 4: Significant Progress

At the four-week mark, the wound had reduced to approximately 1.6 cm by 1.2 cm. Healthy epithelial tissue was beginning to close the wound from the edges. The pain while walking had noticeably reduced. Mr. Chauhan was now walking around 300 metres, and his wife reported that he was more willing to move around the house independently. The physiotherapist noted improved ankle mobility and better balance during standing exercises. Blood pressure and blood sugar remained well controlled. A doctor review was conducted, and the vascular specialist was updated on the wound progress with photographs.

Wound: 1.6 x 1.2 cm Walking 300m Epithelialization visible
M2

Month 2: Near Closure

By the end of the second month, the wound had reduced to approximately 1.0 cm by 0.8 cm. The wound bed was shallow and almost entirely covered with new epithelial tissue. Nursing visits were reduced to twice per week, focusing on monitoring rather than intensive dressing changes. Mr. Chauhan was walking 400 metres with minimal discomfort. He had started going for short walks in his residential complex with the attendant. Physiotherapy sessions were reduced to three per week. The family reported that his overall mood and confidence had improved significantly. He was sleeping better because the night-time leg discomfort had substantially reduced.

Wound: 1.0 x 0.8 cm Walking 400m Outdoor walks resumed
M3

Month 3 (8 Weeks): Wound Near Complete Closure

At the eight-week assessment, the wound measured 0.8 cm by 0.6 cm with healthy epithelialization across the wound bed. The wound was shallow, clean, and progressing toward complete closure. Walking endurance had improved from 120 metres at discharge to approximately 450 metres. Blood sugar remained well controlled throughout the recovery period. No wound infection or vascular complication had occurred at any point during the home care period. Mr. Chauhan had resumed light outdoor activities, including visits to a nearby park. He remained free from hospital readmission. The care team recommended continuing nursing visits once a week until complete wound closure and maintaining physiotherapy at a reduced frequency.

Wound: 0.8 x 0.6 cm Walking 450m No readmission No infection

Clinical Progress Data

Wound Size Progression Over 8 Weeks

Time PointWound SizeTissue StatusDischargeInfection Signs
Discharge (Day 0)3.5 cm × 2.8 cmHealthy granulationMild serousNone
Week 13.4 cm × 2.7 cmHealthy granulationMild serousNone
Week 22.8 cm × 2.2 cmHealthy granulationMinimal serousNone
Week 41.6 cm × 1.2 cmEpithelialization beginningMinimalNone
Week 6 (Month 2)1.0 cm × 0.8 cmEpithelialization advancingScantNone
Week 8 (Month 3)0.8 cm × 0.6 cmNear complete epithelializationScant / absentNone

Walking Endurance Progression

Time PointWalking DistancePain During WalkWalking Aid
Discharge120 metresMild painWalking stick
Week 1150 metresMild pain, slightly lessWalking stick
Week 2200-220 metresMild, manageableWalking stick
Week 4300 metresNoticeably reducedWalking stick
Week 6 (Month 2)400 metresMinimalWalking stick
Week 8 (Month 3)450 metresMinimal discomfortWalking stick

Blood Pressure and Glycemic Control During Home Care

ParameterAt DischargeWeek 4Week 8Trend
Blood Pressure132/80 mmHg130/78 mmHg128/76 mmHgStable
Fasting Blood SugarWithin targetWithin targetWithin targetControlled
Post-Prandial Blood SugarWithin targetSlight elevation (Week 1), correctedWithin targetControlled

Family Education and Emergency Preparedness

Education of the family caregivers was a continuous process throughout the eight weeks. Mr. Chauhan’s wife and son were taught to perform daily visual inspection of the affected leg, looking specifically for any increase in redness, swelling, drainage, or pain around the wound. They were instructed on the importance of maintaining good diabetes control, as even short periods of hyperglycemia can slow wound healing and increase infection risk.

The family was counselled on medication adherence. After angioplasty with stent placement, antiplatelet medications are essential to prevent stent thrombosis. Missing even a few doses can be dangerous. The medication organizer was set up to help with this, and the attendant provided daily reminders.

A critical part of the education involved recognizing warning signs that would require immediate medical attention. These included sudden severe leg pain, coldness or pallor of the limb, black discoloration of the skin around the wound, fever, or rapidly worsening wound appearance. The family was informed about why apparently stable patients can sometimes deteriorate suddenly, particularly in the context of vascular disease.

Given that Mr. Chauhan lives in Greater Noida, where traffic on the Noida-Greater Noida Expressway and around Pari Chowk can delay ambulance response, the family was advised to have a clear plan for accessing the nearest emergency facility. The location of the nearest hospital was confirmed, emergency contact numbers were posted visibly in the home, and the family was oriented on what to do in the first thirty minutes of a home emergency. The importance of emergency preparedness training for family members was discussed, and the attendant was briefed on the protocol for calling an ambulance if needed rather than waiting for family consensus.

Warning Signs Requiring Immediate Hospital Visit

  • Sudden severe pain in the affected leg that does not resolve with rest
  • Coldness, paleness, or bluish discoloration of the foot or toes
  • Black or dark discoloration of the skin near or around the wound
  • Fever above 100.4°F associated with wound redness or swelling
  • Rapidly increasing wound size, pus, or foul odour from the wound
  • Inability to move the toes or loss of sensation in the foot

Recovery Outcome at 8 Weeks

Wound Status

Reduced from 3.5 x 2.8 cm to 0.8 x 0.6 cm with healthy epithelialization. No infection occurred at any point during the recovery period.

Mobility

Walking endurance improved from 120 metres to approximately 450 metres with minimal discomfort. Light outdoor activities resumed.

Glycemic Control

Blood sugar remained well controlled throughout the eight-week period, supporting consistent wound healing.

Medical Stability

Blood pressure stable. No vascular complications. No stent-related issues. No hospital readmission required.

Quality of Life

Patient reported reduced anxiety, better sleep, improved confidence in walking, and greater independence in daily activities.

Remaining Challenges

Wound not yet fully closed. Long-term vascular monitoring needed. PAD management is ongoing. Risk of new lesions in the same or other limb persists.

Care Goals: Planned vs Achieved

Short-Term Goals

  • Promote wound healing

    Achieved: Wound reduced by over 90% in surface area

  • Reduce pain during walking

    Achieved: Pain reduced from mild to minimal

  • Prevent wound infection

    Achieved: No infection at any point

  • Improve circulation

    Achieved: Angioplasty restored flow; exercises maintained it

  • Restore confidence in mobility

    Achieved: Patient resumed outdoor walks independently

Long-Term Goals

  • Achieve complete ulcer healing

    In progress: Wound nearly closed, continuing care

  • Maintain healthy blood flow

    Ongoing: Requires medication adherence and follow-up

  • Prevent future vascular complications

    Ongoing: Lifestyle modifications and regular vascular review needed

  • Improve physical endurance

    Substantially achieved: Walking distance nearly quadrupled

  • Preserve independent living

    Achieved: Independent in most ADLs, outdoor mobility restored

Key Clinical Learnings

1

Restoring blood flow is a prerequisite, not a substitute, for wound care

The angioplasty opened the blocked artery and improved peripheral pulses. However, the wound still required eight weeks of professional dressing, infection monitoring, and metabolic control to heal. Restoring blood flow creates the conditions for healing, but the healing process itself still needs active management. In this case, home nursing provided that management in a setting that was safer and more comfortable for the patient than an extended hospital stay.

2

Diabetes control directly influenced wound healing velocity

When the post-prandial blood sugar showed a slight elevation in the first week, the nursing team communicated this to the family immediately. Dietary adjustments were made, and the next readings returned to target. This early correction likely prevented a period of slowed healing that could have extended the recovery timeline. In diabetic patients with vascular wounds, daily blood sugar monitoring at home is not optional. It is a clinical necessity that directly affects outcomes.

3

Physiotherapy served both rehabilitation and vascular maintenance purposes

The physiotherapy program was not only about rebuilding walking endurance. The ankle mobility exercises, lower limb strengthening, and circulation-enhancing exercises also promoted blood flow through the healing limb. In peripheral artery disease, muscle activity in the affected limb acts as a pump that assists arterial inflow and venous return. Structured exercise, supervised by a physiotherapist who understood the vascular context, contributed to both functional recovery and ongoing circulatory health.

4

The attendant role provided a safety net that clinical visits alone could not

The nurse visited daily for the first two weeks and then on alternate days. But the patient needed supervision and support during all waking hours. The attendant filled this gap by monitoring walking, ensuring leg elevation, providing medication reminders, and watching for any change in condition between clinical visits. For an elderly patient with a healing wound and multiple comorbidities, this continuous presence was a meaningful contributor to safety, particularly because the primary caregiver was also elderly.

5

Emergency preparedness is especially relevant for vascular patients living in peripheral areas of the NCR

Patients with peripheral artery disease and recent stent placement carry a small but real risk of acute re-occlusion. If this occurs, the window for intervention is limited. For residents of Greater Noida, particularly in sectors farther from major hospitals, understanding when to call an ambulance without delay and having a pre-planned route to the nearest emergency facility is clinically important. This case reinforced that emergency preparedness education should be a standard part of discharge planning for vascular patients, not an afterthought.

Medical Authorship and Review

Dr. Ekta Fageriya

Dr. Ekta Fageriya, MBBS

RMC Registration No. 44780

Geriatric Medicine 7 Years Clinical Experience

Author and Clinical Reviewer

Supporting Clinical Documents

This case study is based on the following clinical documentation. Patient-identifiable information has been removed to maintain confidentiality.

Hospital Discharge Summary

Primary reference document

Vascular Investigation Reports

Doppler ultrasound and angiography findings

Blood Investigation Reports

Including glycated hemoglobin and lipid profile

Prescription and Medication List

Discharge medication orders

Home Care Nursing Progress Notes

Daily and weekly documentation

Wound Measurement Records

Serial documentation with dates

Frequently Asked Questions

Peripheral Artery Disease is a condition where the arteries that supply blood to the limbs become narrowed due to atherosclerotic plaque buildup. This reduces the amount of oxygen and nutrients reaching the tissues. When a wound occurs in an area with reduced blood supply, the body cannot deliver the immune cells, nutrients, and oxygen needed for normal healing. This is why wounds in patients with PAD often become chronic and non-healing. Restoring blood flow through procedures like angioplasty is usually necessary before wound healing can progress effectively.

After angioplasty, the patient is typically stable enough to leave the hospital, but the underlying wound still needs professional care. Home nursing ensures that sterile dressing changes, wound measurement, infection monitoring, and medication supervision continue in the patient’s own environment. A nurse can also monitor for complications such as stent thrombosis, bleeding at the access site, or signs of re-occlusion. Without this professional support, the wound care burden falls on family members who may not have the training to perform these tasks safely.

There is no fixed timeline because healing depends on multiple factors including the patient’s age, diabetes control, nutritional status, wound size, and whether infection is present. In this case, the wound showed significant reduction over eight weeks but had not fully closed by that point. For diabetic patients with PAD, complete healing of a chronic ulcer can take anywhere from a few weeks to several months. The key is consistent wound care, good glycemic control, and regular monitoring to ensure the wound is progressing in the right direction.

The warning signs include sudden severe pain in the leg that does not improve with rest, coldness or paleness of the foot or toes, blue or black discoloration of the skin, numbness or tingling in the foot, inability to move the toes, fever with increasing wound redness or swelling, pus or foul odour from the wound, and rapidly increasing wound size. Any of these signs require immediate medical attention. Families should not wait to see if the symptoms improve on their own, as delayed treatment of vascular complications can lead to irreversible tissue damage.

Yes. Diabetes affects wound healing through multiple mechanisms that are independent of blood flow. High blood sugar impairs the function of white blood cells, reducing the body’s ability to fight infection. It also slows down collagen synthesis, which is necessary for wound closure. Diabetes can cause neuropathy, meaning the patient may not feel pain from a developing infection or pressure injury. Additionally, diabetes affects the small blood vessels (microcirculation) in ways that angioplasty of larger arteries does not fully address. This is why glycemic control remains a critical part of wound management even after blood flow to the area has been restored.

Physiotherapy served multiple purposes in this case. First, the patient had reduced walking endurance due to weeks of limited activity caused by leg pain. Structured walking rehabilitation helped rebuild stamina gradually and safely. Second, ankle mobility exercises prevented joint stiffness that commonly develops when a person reduces walking. Third, lower limb strengthening exercises improved muscle support for the ankle joint. Fourth, circulation-enhancing exercises promoted blood flow through the healing limb. Finally, balance training reduced the risk of falls, which is especially important for an elderly patient using a walking stick who has an open wound on one leg.

A trained patient attendant provides continuous supervision and assistance during the hours when a nurse is not present. In this case, the attendant supervised walking within the home, ensured meals were taken on time, provided medication reminders between nurse visits, assisted with leg elevation to manage swelling, and monitored for any change in the patient’s condition. The attendant also provided relief to the elderly primary caregiver, who could not be expected to provide round-the-clock supervision. This role is distinct from nursing in that it focuses on safety, comfort, and daily routine rather than clinical procedures.

Signs of wound infection include increasing redness around the wound that spreads outward, swelling or warmth in the surrounding skin, increased pain that is worsening rather than improving, pus or cloudy discharge from the wound, a foul or unusual odour, fever or chills, and red streaks extending from the wound toward the body. In diabetic patients, these signs may be less obvious because neuropathy can mask pain. This is why professional wound assessment by a trained nurse is important. A family member inspecting the wound may not notice subtle early changes that a nurse would identify.

Walking is generally safe and beneficial for a healing leg ulcer, provided it is done under guidance and the blood flow to the area has been restored. In fact, gentle walking promotes circulation to the lower limb, which supports wound healing. However, the walking should be supervised initially, should not cause severe pain, and should be gradually increased in distance as tolerated. Walking on an ulcer without adequate blood flow, or walking to the point of severe pain, can be harmful. In this case, walking was introduced gradually under physiotherapy supervision, starting well below the patient’s tolerance and progressively increasing as the wound healed and comfort improved.

A patient with PAD should be taken to the hospital immediately if they develop sudden severe pain in the affected limb that does not resolve with rest, if the foot or toes become cold, pale, or blue, if there is sudden numbness or paralysis of the foot or toes, if the skin near the wound turns black or dark, if there is fever with rapidly worsening wound appearance, or if there is sudden heavy bleeding from the wound or the angioplasty access site. These symptoms may indicate acute limb ischemia, stent thrombosis, or severe infection, all of which require emergency hospital treatment. Emergency preparedness training for family members can help ensure that these situations are recognized and acted upon without delay.

Related Reading

Medical Disclaimer

This case study is presented for educational and informational purposes only. Every patient is unique, and the clinical outcomes described here are specific to this individual case. Treatment decisions must always be made by qualified healthcare professionals based on a thorough evaluation of the patient’s specific medical condition, history, and circumstances.

Emergency symptoms such as sudden severe pain, coldness or discoloration of a limb, difficulty breathing, chest pain, or loss of consciousness require immediate hospital care. Home healthcare complements, but does not replace, emergency medical services. If you or a family member experience any of these symptoms, call an ambulance or go to the nearest emergency department immediately.

The patient details in this case study have been modified to protect confidentiality. Any resemblance to actual persons, living or deceased, is coincidental. Do not use this information to self-diagnose or self-treat any medical condition.

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