Neuropathic ulcer
Pathophysiology
Due to any cause of senosry loss: area of skin damage not noticed by patient
- Idiopathic (50-60%)
- Systemic: DM, SLE, hypothyroidism, vasculitis
- Drugs: amiodarone, alcohol, toxins
- Infections: TB, leprosy, HIV
Approach
- Inspect
- Site: formed over pressure areas (metatarsal heads, sole of foot, balls of toes)
- Shape: irregular, correspond to shape of pressure point that has become exposed
- Edge / base: clean, base may be deep with exposure of bone and tendon
- Surrounding skin: normal blood supply
- Palpate
- Temperature of surrounding skin
- Peripheral pulses usually normal
- Sensation
- Percuss
- Auscultate
Completion
- Perform complete neurological examination
- Cranial nerve examination
