Healing to Remission: Clinician’s Guide to Manage Diabetic Foot Ulcers, Peripheral Artery Disease

 When a diabetic foot ulcer (DFU) closes or a patient with chronic limb-threatening ischemia (CLTI) completes revascularization, it can feel like the battle is over. But, as the recent International Wound Journal analysis shows, that moment is often just the start of a high-risk phase — one that rivals aggressive cancers in the likelihood of recurrence.

Three-year DFU recurrence rates hover around 58%, and CLTI reintervention rates after endovascular therapy approach 50%. These figures are not outliers; they are the median reality. In oncology, physicians would never consider a patient with a resected tumor margin “finished” with treatment. The presence of that margin signals the need for vigilant, structured follow-up — and DFU and CLTI remission should be approached the same way.

Language Matters

One of the most powerful shifts we can make is linguistic: replacing “healed” with “in remission.” This small change reframes both clinician and patient expectations. It signals that the ulcer or ischemic event was not a one-off but a manifestation of an ongoing disease process that demands surveillance and intervention.

Patients who hear “in remission” are more likely to remain engaged in follow-up, adhere to preventive strategies, and recognize early warning signs, all of which directly reduce recurrence risk.

Limb-Preservation Plans

Clinicians can borrow a page from oncology’s use of cancer survivorship care plans and create limb-preservation plans for their diabetic patients. Here’s how to translate that concept into practical action:

• Conduct structured surveillance. This involves foot checks every 1-3 months in the first year post-healing, then at risk-based intervals for patients with DFUs and regular vascular assessments, particularly within the first 18 months when reintervention risk is highest, for patients with CLTI.
• Promote technology-enabled prevention. This entails encouraging patients to use thermometry to detect early inflammation and to consider remote monitoring tools that alert their clinicians to concerning temperature, moisture, or pressure changes.
• Address the importance of footwear. This means prescribing protective footwear designed for pressure redistribution and reinforcing the message that footwear is not optional; it’s part of the therapy.
• Educate patients on self-management. This involves training patients to perform daily self-checks (or have caregivers assist) and emphasizing the significance of even small skin changes or redness.
• Provide lifestyle and comorbidity management. This entails aggressively managing glucose, lipids, and blood pressure, as well as encouraging patients to engage in physical activities that maintain circulation without increasing ulcer risk.
• Monitor patients’ psychosocial support. This includes screening for depression and social isolation, both of which are associated with worse self-care and higher recurrence.

Making It Stick

We have data, technology, and proven prevention strategies. The barrier isn’t evidence — it’s implementation. Integrating survivorship thinking into limb preservation means establishing clinic protocols, securing multidisciplinary buy-in, and advocating for policy and reimbursement structures that recognize DFU and CLTI as chronic, high-risk conditions.

The cancer analogy isn’t a dramatic metaphor; it’s a call to match the vigilance, structure, and urgency that oncology has embraced for decades. By treating the end of a DFU or CLTI episode as the start of remission, we can improve long-term outcomes, protect limbs, and, most important, help our patients stay on their feet and in their lives.

David G. Armstrong, DPM, MD, PhD

Distinguished Professor, Department of Surgery and Neurological Surgery; Director of Limb Preservation, University of Southern California, Los Angeles, California

Disclosure: David G. Armstrong, DPM, MD, PhD, has disclosed no relevant financial relationships.

https://www.medscape.com/viewarticle/healing-remission-clinicians-guide-managing-diabetic-foot-2025a1000nco