Malum perforans

Last Updated: 2020-11-19

Author(s): -

Mal perforans, mal perforant, anesthetic ulcers, perforating ulcers, neurotrophic ulcers, neuropathic ulcers, neuropathic ulcers.

Ulcerations at pressure-loaded sites in areas of disturbed pain sensation and skin innervation with no healing tendency.

More common in diabetics and polyneuropathy.

Diseases that can trigger polyneuropathy: 

  • Neuropathic polyneuropathy in peripheral nerve lesions

  • Traumatic nerve injuries (ischiadic nerve, tibial nerve)

  • Diabetes mellitus

  • Leprosy

  • Syphilis (Tabes dorsalis)

  • Alcoholism (Bureau Barrière Syndrome)

  • Amyloid neuropathy

  • Syringomyelia

  • Spinalis anterior syndrome

  • Congenital pain insensitivity

  • Trophoneurotic nasal wing ulcer

Ulcerations mostly occurring in the area of the plantar pressure points.

  • Anamnesis 
    • With regard to underlying diseases
  • Clinical features
    • Testing the pain sensation in the affected area
  • Biopsy
    • for exclusion of ulcer eradication
  • Neurological consultation, if necessary

Especially plantar.

Osteomyelitis.

With known polyneuropathy, adapted footwear and frequent checks for pressure points.

  • Often a complete healing is not possible.
  • In some cases an amputation is unavoidable.
  • Pressure relief
  • Infection prophylaxis
  • If necessary, surgical corrections for orthopaedic malpositioning
  • Treatment of the underlying disease
  • Stage-specific ulcer treatment
  • Plastic covering is often not very successful.
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