neuropathic ulcer

Etiology

• repetitive skin trauma
• diabetic neuropathy

Pathology

• occurs due to unrecognized trauma to insensate feet
• ulcers are generally much deeper & wider than their surface appearance suggests
• commonly surrounded by a thick, macerated rim of hyperkeratosis

Clinical manifestations

• generally asymptomatic (painless), except for associated diabetic paresthesias
• occur primarily on plantar aspect of the foot, especially in the region of the metatarsal heads
• thickened surrounding hyperkeratosis is common

* image

Diagnostic procedures

• ankle-brachial index

Radiology

• X-ray of foot
• computed tomography
• bone scan

Complications

• osteomylelitis
• amputation

Management

• rule out or rule in osteomyelitis
• assess vascular supply
• debridement of necrotic tissue
• offload pressure
  • appropriate footwear vs total-contact casting
• prevention & early identification in patients with diabetes mellitus
  • self daily examination of feet
  • professional foot examination every clinic visit

More general terms

• cutaneous ulcer
• chronic skin disease
• chronic neurologic disease

More specific terms

• diabetic foot ulcer; diabetic foot lesion; diabetic lower extremity lesion

Additional terms

• arterial ulcer
• pressure ulcer (decubitus ulcer, bedsore)
• venous stasis ulcer