Last Updated: 2022-02-04
Author(s): Anzengruber F., Navarini A.
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
- Syphilis (Tabes dorsalis)
- Alcoholism (Bureau-Barrière syndrome)
- Amyloid neuropathy
- Spinalis-anterior syndrome
- Congenital insensitivity to pain
- Trophoneurotic nasal ulcer
Mostly ulcerations occurring in the area of the plantar pressure points.
- In terms of underlying diseases
- 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
- To exclude a roden's ulcer (remember, this is not so rare and is sometimes missed for a long time.)
- If necessary, neurological consultation
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.
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