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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 [1]
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 [3]
Complications:
- osteomylelitis
- amputation
Special laboratory:
- ankle-brachial index
Radiology:
- X-ray of foot
- computed tomography
- bone scan
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
Related
arterial ulcer
pressure ulcer (decubitus ulcer, bedsore)
venous stasis ulcer
Specific
diabetic foot ulcer; diabetic foot lesion; diabetic lower extremity lesion
General
cutaneous ulcer
chronic skin disease (chronic dermatologic disorder, chronic dermatopathy, chronic dermatosis)
chronic neurologic disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18.
American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- Boulton AJ.
What you can't feel can hurt you.
J Vasc Surg. 2010 Sep;52(3 Suppl):28S-30S
PMID: 20804930
- London Health Sciences Centre (image)
Diabetic/Neuropathic Ulcer
http://www.lhsc.on.ca/Health_Professionals/Wound_Care/diabetic.htm