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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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