Most wound-care claims are not about one bad decision. They are about a foot wound that was measured and dressed visit after visit while the three things that decide whether it heals — pressure taken off it, blood flow into it and infection kept out of it — were not addressed. I review wound-care claims for plaintiff and defense counsel as a board-certified foot and ankle surgeon whose practice includes wound care and diabetic limb salvage, and I am direct about which questions a podiatric opinion answers and which need another specialty.

Where these cases come from

• Dressings without offloading — a neuropathic plantar ulcer managed for weeks with dressing changes and a post-operative shoe, with no total contact cast, removable walker or other device that actually unloads the wound
• A stalled wound and no vascular work-up — no documented pulses, no ankle-brachial index or toe pressures, and no referral while the ulcer failed to close
• Infection recognised late — cellulitis, abscess or osteomyelitis missed because no probe-to-bone test, X-ray, MRI or inflammatory markers were obtained, or because abnormal results were not acted on
• Delayed escalation — a worsening wound kept in the office or on home health when it needed admission, surgical debridement or drainage
• Wounds caused by routine care — a nail procedure, callus paring or debridement in a patient with known arterial disease that became a wound of its own
• Surgical wound breakdown after foot and ankle surgery, including dehiscence and deep infection
• Pressure injuries of the heel and foot acquired in hospitals, rehabilitation units and nursing homes

Where my opinion stops

I am a foot and ankle surgeon. I can speak to the wound itself — how it should have been classified, offloaded, debrided and followed — to the recognition and treatment of foot infection, to podiatric surgical options up to and including partial foot amputation, and to whether the foot care met the standard. If the case turns on the timing or conduct of vascular surgery, on an amputation above the ankle, on management of the patient’s diabetes itself, or on nursing practice inside a hospital or nursing home, you need that specialist as well — and I will tell you so at the conflict check, not after you have paid for a report.

What the record has to show

• Measurements over time. Length, width and depth at each visit, ideally with photographs. The trajectory matters more than any single note: a diabetic foot ulcer that has not shrunk meaningfully in about four weeks is a recognised signal that the plan needs to change.
• The offloading plan, and whether it happened. The chart should name the device, when it was dispensed, and whether the patient could, and did, wear it.
• Perfusion. Pulses, and objective testing when they are weak or the wound stalls. In diabetes the ankle-brachial index can read falsely normal because calcified arteries do not compress, so toe pressures or transcutaneous oxygen are often the more honest numbers.
• Infection and what followed. Probe-to-bone findings, imaging, deep tissue or bone cultures rather than surface swabs, and when antibiotics started.
• Referral and escalation. When vascular, infectious disease or surgical consultation was requested, and how long it took to happen.
• The patient’s side of the record. Glucose control, smoking, missed visits and documented non-adherence. They are often the core of the defense, and they deserve a straight reading either way.

Causation, medically

Many of these patients arrive with neuropathy, arterial disease and a history of prior ulcers, so causation is usually contested from the start. The question I work through is narrower: whether a specific, earlier step — offloading, a vascular referral, imaging, admission — would more likely than not have changed the outcome, and how much time was actually lost. Sometimes the honest answer is that it would not have, and I will say so. Where the case ends in limb loss, how diabetic amputation claims are evaluated sets out the rest of that chain.

Before a review, the records checklist lists what to send, including the vascular studies these cases often turn on. For Michigan matters, see what qualifies a podiatric expert under Michigan law.