Neuropathic ulcers are the results of peripheral neuropathy ie. reduction or loss of sensation due to nerve damage particularly in patients suffering from diabetes. In simple words, individuals with peripheral neuropathy are not able to feel any pain or discomfort from traumatic events. They typically occur on the lower limbs such as feet or legs and the local paresthesias or loss of sensation over pressure points leads to extended microtrauma, tissue breakdown, and eventual ulceration as well. In addition, it can also result in minor scrapes or cuts, if left untreated, they develop into ulcers.
Clinical Features of Neuropathic Ulcer
Typically, patients who suffer from neuropathic ulcers have a history of peripheral neuropathy or symptoms of peripheral vascular disease. It generally affects the sensory nerves that detect sensations such as temperature or pain; however, it can also affect the motor nerves which can further cause muscle wasting, leading to the imbalance of flexor and extensor muscles to develop foot deformities such as claw toes, etc.
Symptoms of Neuropathic Ulcers
The recognizing base of neuropathic ulcers can vary depending on the patient’s circulation from reddish to brown/black. The injuries will have a clear & punched-out look, while the surrounding skin may feel hardened. Sometimes, an undermining in the wound can be seen and infection in the underlying tissue can lead to osteomyelitis (infection of the bone or bone marrow) if left untreated. In case the patients notice any of these signs, they should immediately contact wound care at the bedside. If there is pressure-related ischemia with neuropathy, the infection may occur. These types of wounds are typically painless unless the infection is not developed.
Causes of Neuropathic Ulcers
As mentioned above, if the patient who has diabetes suffers from repeated pressure on the lower limbs that have decreased sensations, it can trigger the development of Neuropathic Ulcers. However, if the wound occurs in an area due to any trauma instead of pressure points, there can be a vascular impairment that can lead to ulceration. This demonstrates the key role of neuropathy in combination ulcers. The most common causes of neuropathic ulcers include:
- Any neurological condition
- Diabetes
- Renal failure
- Trauma
- Surgery
Some of the less common conditions that can trigger the development of neuropathic ulcers include chronic leprosy, spina bifida, and syringomyelia.
Diagnosis of Neuropathic Ulcers
The doctors will perform examinations of blood glucose levels in addition to serum B12 levels. In addition, they can also access concurrent arterial disease. To recognize the signs of infection, a microbiology swab is required along with evidence of deep infection such as visible bone or ulcers increasing into joints. Plus, it is also essential to assess the extent of peripheral neuropathy. Diabetic persons are more prone to develop this type of ulcer and thereby they should consult risk factors with bedside wound care in California.
Treatment of Neuropathic Ulcers
Wound Care Experts perform a debridement procedure to debride the wound to healthy, bleeding tissues. Sometimes there is the presence of infection underneath the superficial layers of necrotic tissue that can spread into the bone and bone marrow. Here, debridement helps in better assessment of the ulcer as well as underlying infections and provides a healing environment. Typically, a moist environment is always favorable for a wound to properly heal. Additionally, a suitable type of dressing is also important.
