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| Neuropathic ulcers may occur in patients with diabetes, spinal cord injury, Hansen's Disease, or other conditions that result in loss of sensation in the legs and feet. Diabetic foot ulcers are most commonly caused by peripheral neuropathy and peripheral vascular disease. (When the diabetic wound occurs in a patient with peripheral vascular disease alone, refer to educational materials on Arterial Leg/Foot Ulcers.) |
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| Neuropathy is caused by prolonged glucose elevation and involves sensory and motor changes. Sensory neuropathy leads to loss of sensation which is a protective function. The patient is unable to feel pain or discomfort so that friction from improperly fitting shoes, foreign objects in the shoes, or injuries from stepping on an object with bare feet does not result in corrective actions. Under these circumstances, patients may develop ulcerations, and they may not be aware of the injury. Motor neuropathy may result in deformities of the foot (Charcot deformities), thinning of the fat pad of the plantar area of the foot, and mid foot collapse with loss of the arch of the foot. These changes affect alignment of the foot and pressure distribution during ambulation which may result in pressure ulcers. |
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Neuropathic ulcers typically share the following characteristics:
- May occur on any part of the leg, but are most commonly seen at the ankle and foot, particularly at the plantar surface and metatarsal heads
- Varied wound depth
- Even, well-defined wound margins
- Varied presence and amount of necrotic tissue or exudate
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| Neuropathic foot ulcers are staged using numerous systems. For simplicity, these ulcers have been classified as partial-thickness which involves the epidermis and dermis, or full-thickness which involves deeper tissue such as subcutaneous tissue, muscle, bone, and other supporting structures. In diabetics, if bone is exposed, 85% of the cases have osteomyelitis. |
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The periwound and leg/foot skin may demonstrate the following changes:
- A circumferential callous
- Erythema
- Maceration
- Cellulitus
- Palpable pulses (usually present)
- Warm skin temperatures
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| Multidisciplinary management of these patients with early intervention and close monitoring is key to prevention and proper treatment of complications such as gangrene and osteomyelitis which may result in amputation. |
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