Malum perforans

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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