Malum perforans

Last Updated: 2022-02-04

Author(s): Anzengruber F., Navarini A.

ICD11: -

Mal perforans, neuropathic ulcer.

Ulcerations at pressure-loaded localisations in areas of disturbed pain sensation and skin innervation with a lack of healing tendency.

Common in diabetics and polyneuropathy.

Diseases that can trigger a polyneuropathy:

  • Neuropathic polyneuropathy in peripheral nerve lesions.
  • Traumatic nerve injuries (sciatic nerve, tibial nerve)
  • Diabetes mellitus
  • Leprosy
  • Syphilis (Tabes dorsalis)
  • Alcoholism (Bureau-Barrière syndrome)
  • Amyloid neuropathy
  • Syringomyelia
  • Spinalis-anterior syndrome
  • Congenital insensitivity to pain
  • Trophoneurotic nasal ulcer

Mostly ulcerations occurring in the area of the plantar pressure points.

  • Anamnesis
    • In terms of underlying diseases
  • Clinic
    • Testing for pain sensation in the affected area
    • Probe-to-bone --> probe the ulcer with a sterile stick, if a hard or porous structure is palpated, the test is positive. If this is not the case, then osteomyelitis is unlikely
  • Biopsy
    • To exclude a roden's ulcer (remember, this is not so rare and is sometimes missed for a long time.)
  • If necessary, neurological consultation

Mostly plantar.

Osteomyelitis.

If you have a known polyneuropathy, wear adapted footwear and check frequently for pressure sores.

  • Often complete healing is not possible.
  • In some cases, amputation is unavoidable.

  • Pressure relief
  • Infection prophylaxis
  • If necessary, surgical corrections in case of orthopaedic malposition
  • Treatment of the underlying disease
  • Treatment of ulcers according to stage

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