The Wounds We Don’t Heal: Reframing Palliative Wound Care in Podiatric Medicine

Chronic lower-extremity wounds represent a significant and growing challenge in podiatric practice, particularly among patients with advanced vascular disease, diabetes, malignancy, and medical frailty. Despite substantial advances in wound care technologies and limb preservation strategies, a considerable proportion of wounds remain biologically nonhealable or clinically incompatible with aggressive curative treatment. In these contexts, the traditional paradigm of wound closure as the primary outcome becomes insufficient and may contribute to unnecessary treatment burden and patient suffering. This paper reframes palliative wound care as an essential component of foot and ankle practice, emphasizing symptom management, patient-centered goals, and quality of life. Chronic wounds are conceptualized as multidimensional conditions that extend beyond tissue loss to include pain, odor, exudate, impaired mobility, social isolation, and loss of independence. For many patients, these symptoms define the lived experience of disease more than wound size or appearance. To support clinical decision-making, two complementary frameworks are introduced: the CORE Framework for Palliative Wound Care (Categorize, Orient, Relieve, Enable) and the Symptom Quadrant of Palliative Wound Care (pain, odor, exudate, infection). Together, these models provide structured, practical approaches for aligning treatment with biologic reality and patient-defined priorities. Palliative wound care is not the absence of treatment, but a deliberate and goal-concordant approach to reducing suffering and preserving dignity. In patients with nonhealable wounds, success is not always defined by closure, but by the ability to improve comfort, maintain function, and enhance quality of life.