Making Wound Care Accessible
Expert Arterial Ulcer Care You Can Trust
If you’re living with a painful sore on your toes, foot, or ankle that isn’t healing, or you’ve noticed black, dry tissue (gangrene), you may have an arterial (ischemic) ulcer caused by poor blood flow. These wounds carry a higher risk of infection and limb loss, so fast, specialized care matters.
At Hill Country Wound Care & Hyperbarics, our physician-led team evaluates circulation, stabilizes the wound, and coordinates vascular treatment when needed, then delivers advanced outpatient therapies to help you heal safely and prevent complications.
What Are Arterial (Ischemic) Ulcers?
Arterial ulcers develop when narrowed or blocked arteries (most often from peripheral artery disease, or PAD) limit oxygen-rich blood to the skin. They’re typically painful, have “punched-out” edges, and most often appear on the tips of toes, the outer ankle/heel, or other pressure points on the foot. Skin may be cool, shiny, or hairless, with weak or absent pulses. Risk factors include diabetes, smoking, high blood pressure, high cholesterol, kidney disease, and older age.
Your Personalized Arterial Ulcer Healing Plan
In-Depth Vascular Evaluation
We perform a focused wound exam with bedside circulation testing, such as handheld Doppler and ankle-brachial or toe pressure checks, and order imaging (X-ray to screen for bone involvement; advanced studies as indicated). This shows how much blood flow your wound actually receives so we can plan the safest next steps.
Rapid Ischemia Management & Vascular Coordination
When blood flow is inadequate, we coordinate urgent referral to trusted vascular specialists for revascularization (angioplasty/stent or bypass). We also work with your primary clinicians on risk-factor medications (e.g., antiplatelets, statins) and smoking cessation resources to protect long-term limb health.
Ischemia-Safe Wound Care
Until circulation is restored, debridement is conservative or deferred (especially for dry, stable eschar). We protect viable tissue, manage moisture without maceration, and avoid compression on arterial-only disease. After revascularization improves perfusion, we resume appropriate debridement to speed healing.
Infection Detection & Control
We culture when needed, treat infection promptly, and screen for deeper involvement (like osteomyelitis) if signs suggest it. Early control of bioburden reduces complications and supports closure.
Offloading & Pressure Redistribution
If your ulcer is on a weight-bearing area, we use offloading strategies (protective footwear, walkers/boots, padding, toe spacers) to reduce pressure and friction while the wound heals.
Advanced Therapies (When Perfusion Allows)
Once adequate blood flow is documented, or when revascularization isn’t possible but tissue oxygenation metrics support it, we may add:
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Cellular/tissue-based products to jump-start stalled healing.
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Negative pressure wound therapy (NPWT) for appropriate, well-perfused wounds.
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Hyperbaric oxygen therapy (HBOT) in select ischemic wounds to boost tissue oxygenation and support angiogenesis under physician supervision.
Whole-Person Support & Prevention
We teach daily foot checks, skin protection, shoe/sock selection, and home care. We coordinate glucose control, nutrition, and blood-pressure/cholesterol optimization with your medical team to prevent recurrence.
Day-to-Day Wound Care (At Home)
Follow your clinician’s plan, which may include gentle wound cleaning, applying prescribed treatments to the wound and surrounding skin, covering the wound with appropriate dressings, and wearing protective/offloading footwear to take pressure off the foot and toes.
Pain management: Tell us about your pain, options include oral and topical medications tailored to type and frequency.
Home Care & Prevention Tips
Do
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Inspect your legs and feet daily (including between toes and the bottoms with a mirror). Look for red spots, cracks, blisters, calluses, or other changes.
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Check shoes/socks daily for pebbles or holes; wear properly fitting footwear (diabetic shoes if you have diabetes) and moisture-wicking socks.
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Wash and dry feet and between toes thoroughly; moisturize dry skin as directed (not between toes).
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Keep up with routine care: take medicines as prescribed, eat a balanced diet, quit smoking, and maintain a healthy weight.
Don’t
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Go barefoot or wear thin slippers, use protective clothing and footwear to avoid injury.
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Soak your feet (it dries skin and hot water can burn without you realizing).
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Remove/trim ingrown or thick toenails yourself, see a clinician.
When to Call Us Immediately
Call us promptly if you notice any of the following:
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New or worsening pain, a white/purple foot, decreased pulses, coldness, numbness, or difficulty moving
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Redness, blistering, a new skin opening, or other signs of infection
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Fewer than three days of dressing supplies remaining
Signs of infection can include: fever/chills, nausea/vomiting, unusual blood sugar spikes, increasing pain, redness around the wound, warmth, swelling, or increased/odorous drainage.
Why Choose Hill Country?
From board-certified physicians to cutting-edge therapies and three convenient locations across San Antonio, we deliver personalized, compassionate care tailored to your healing journey. Our affordable outpatient model and patient-first approach ensure you get the right treatment, when and where you need it.
1. Largest Private, Physician-Led Network
San Antonio’s most extensive private outpatient wound-care & hyperbarics network, led by board-certified physicians.
2. Physician-Led, Patient-First
You’re supervised by a medical doctor at every step, with a plan that adapts as you improve.
3. Convenient Locations
Three Advanced Healing Centers, North, East, and Southwest San Antonio, with easy parking and convenient hours, make daily visits a breeze.
4. Affordable Outpatient Model
We accept most major insurances, and our outpatient setup keeps your out-of-pocket costs lower.
Why ORN Is Difficult to Treat
Radiated bone becomes hypoxic (low in oxygen), hypocellular (low in living cells), and hypovascular (poorly perfused). These three conditions make healing extremely difficult, even with antibiotics or surgical removal of damaged bone (sequestrectomy).
Traditional treatments often fail because:
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Radiation scarring narrows arteries and restricts oxygen delivery
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Infection risk increases due to impaired immune response
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Tissue regeneration is limited in poorly oxygenated environments
This is where HBOT plays a critical role in tipping the balance back toward healing.
Frequently Asked Questions
Here are the answers to the questions we hear most about arterial (ischemic) ulcer care, how we check circulation, when we coordinate revascularization, what debridement or offloading looks like, who may benefit from HBOT, and how insurance/coverage works. Use these as a helpful starting point; your plan at Hill Country is physician-led and tailored to you. If you don’t see your question here, call our team and we’ll guide you step-by-step.
It depends on your insurance. Call us and we’ll verify your benefits and requirements.
Most patients start with weekly visits; frequency adjusts based on vascular status, wound severity, and treatments used.
HBOT is considered in select ischemic wounds to increase tissue oxygenation. Your physician will determine candidacy based on evidence, perfusion/oxygenation metrics, and overall risk–benefit.
Daily foot checks, protective footwear, safe skin care, and not soaking feet are key. Report infection signs immediately.
Our billing department is here to help! Call us at (210) 610-8154, and we’ll answer any additional questions you may have.
We accept a variety of payment methods, including credit cards, debit cards, checks, and certain financing options. Contact our billing team if you have any questions about payment methods.
Out-of-pocket costs vary based on your insurance plan, deductibles, and any co-pays. Our billing team can provide an estimate based on your coverage, or you can contact your insurance provider for specific details about your policy.