Neuropathic ulcer

The Neurotrophic Ulcerations is an ulcer or a Hornhautschwiele on the sole of the foot as a result of polyneuropathy. Polyneuropathy is usually caused by diabetes mellitus, which is then referred to as diabetic foot syndrome. In contrast to the leg ulcer is no significant circulatory disorder.

Causes

As a polyneuropathy is a prerequisite for the development of a Neurotrophic Ulcerations, come all diseases that can cause a peripheral nerve injury, a possible cause. By far the most common is diabetes mellitus to call, but also alcohol abuse or a vitamin B12 deficiency can be the cause. In addition to idiopathic polyneuropathy (unknown cause ) are even rarer diseases from the infectious or autoimmune spectrum into account.

Pathogenesis

Due to the nerve damage to the feet, patients get no feedback on the load on the feet when walking, leading to incorrect loading. At locations where the bone is protected only with little fat and they are particularly affected when walking to calluses form. Also the sensation of pain is reduced by peripheral nerve damage, so that at these pressure-loaded skin small injuries are not noticed and can thus rapidly form on damaged skin ulcer.

Complications

Due to the often existing microangiopathy cells are very poorly reach the tissues from the blood. Thus, on the one hand, the repair of the skin defect is difficult, on the other hand are cells of the immune system badly to the open skin area that is potentially portal of entry for a variety of pathogens. The ulcers can quickly expand without proper treatment to the bone and in the worst case, these infected ( osteomyelitis), which often leads to amputation of part of the limbs.

Treatment

First up is the treatment of the underlying disease, which is the underlying polyneuropathy. Professional foot care and relieving footwear should be mandatory. Necrotic portions of the ulcer should be removed and the wound is kept moist under associations. In an infected ulcer therapy with antibiotics should be considered if the bone is already infected, the limb can often only be amputated.