Department
of Podiatry - Vascular Assessment
Neuropathic
Ulceration
A
neuropathic ulcer is a breakdown in tissue that has been induced by trauma
that would have been detected by a person with “normal” peripheral
sensations. As such, these ulcers are typically found in patients with
diabetes due to their advanced development of peripheral neuropathy (Payne,
2000).
However, neuropathic ulcers will not develop purely due to trauma with
neuropathy, and impairment in the vascular circulation will also be present.
Neuropathy therefore plays a large role in development of combination
ulcers.
Archetypal sequelae for development of these ulcers is as follows:
• patient gets a stone in their shoe or purchases a new pair of shoes
that rub on bony prominences
• without sensing the discomfort, walks around all day causing microtrauma
to the subdermal and/or epidermal tissue, to the point of breakdown
• time elapses
• unless the patient checks there feet daily they will not be aware
that changes have occurred
• even if they check their feet, subdermal breakdown will not be
detected due to the neuropathy
• an ulcer forms
Pure neuropathic ulcers typically present over prominent areas of pressure,
on both the plantar aspect and periphery due to rubbing on footwear. Hyperkeratosis
will often be covering and surrounding the ulcer, and a white halo of
macerated fibrous tissue is often present around the immediate borders.
They are usually deep, moist, penetrating ulcers, that are completely
pain free.
Picture
of a neuropathic ulcer overlying the PSIS.
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