Neuropathic ulcer: Symptoms, treatment, and prevention

What is a neuropathic ulcer?

A neuropathic ulcer occurs due to nerve damage, typically in people with diabetes, peripheral neuropathy, or spinal cord injuries. These ulcers commonly occur on the feet and can develop when a person loses sensation in a particular area. As a result, they may be unaware of minor injuries, which can become infected and form a chronic ulcer.

Learn about nerve pain in the foot here.

Symptoms of neuropathic ulcer

The symptoms of a neuropathic ulcer may include:

• a persistent, nonhealing wound that fails to respond to traditional wound healing treatments
• redness or inflammation around the affected area
• swelling or warmth around the ulcer
• numbness or tingling in the affected area
• blood or drainage from the affected skin

People with neuropathy may not always experience pain or discomfort, making it difficult to detect neuropathic ulcer development. To help prevent complications, people with nerve damage must have regular foot inspections and seek prompt medical attention if any concerning symptoms arise.

Causes of neuropathic ulcers

Nerve damage typically causes neuropathic ulcers. They can result from various underlying medical conditions. Some common causes include:

• Diabetes: High blood sugar levels associated with diabetes can cause nerve damage, particularly in the feet.
• Peripheral neuropathy: This condition affects the nerves outside the brain and spinal cord and can have various causes, including alcohol abuse, chemotherapy, and certain infections.
• Spinal cord injuries: Damage to the spinal cord can result in sensation loss in certain areas of the body, making it more challenging to detect minor injuries that can progress to ulcers.
• Charcot foot: Charcot foot is a complication of peripheral neuropathy that causes the bones in the foot to weaken and fracture, leading to ulcers.
• Pressure injuries: Prolonged pressure on a particular area of the foot can cause tissue damage and subsequent ulceration, particularly in people with reduced sensation due to nerve damage.
• Trauma: Injuries to the feet can damage nerves and lead to neuropathic ulcer development.

Learn about diabetic foot problems here.

Diagnosis

Diagnosing a neuropathic ulcer involves a physical exam and a medical history review. Here are some common steps involved in diagnosing neuropathic ulcers:

• Physical examination: A healthcare professional will examine the affected area, looking for signs of ulcers and assessing the severity of any wounds.
• Medical history: They will ask about underlying medical conditions, such as diabetes or peripheral neuropathy, that may increase the risk of neuropathic ulcers.
• Sensory testing: A healthcare professional may perform a sensory test, such as a monofilament test or a tuning fork test, to assess the patient’s sensation in the affected area.
• Imaging tests: X-rays, MRI scans, or other imaging tests may help doctors evaluate the extent of tissue damage, assess for underlying bone infections or deformities, and guide treatment decisions.
• Blood tests: Blood tests can help evaluate blood sugar control in people with diabetes and assess for other medical conditions that may contribute to nerve damage.
• Biopsy: In some cases, a healthcare professional may take a small tissue sample from the affected area for laboratory testing to assess for infections or other underlying causes of the ulcer.

Treatment of neuropathic ulcer

Treatment of neuropathic ulcers typically involves a multidisciplinary approach, including wound care, taking weight off the affected area, managing underlying medical conditions, and medication. Here are some common treatment options for neuropathic ulcers:

• Wound care: Regular wound care promotes healing and prevents infections. This may involve cleaning the wound, removing dead tissue, and applying dressings.
• Offloading: Offloading the affected area can help reduce pressure and promote healing. This may involve using specialized shoes, braces, or casts to redistribute weight.
• Medications: Doctors may prescribe topical or systemic medications, such as antibiotics, analgesics, or growth factors, to control pain, prevent infections, and enhance wound healing.
• Surgery: In severe cases, doctors may recommend surgery to remove dead tissue, repair underlying bone deformities or infections, or amputate a severely damaged limb.
• Management of underlying medical conditions: Proper management of underlying medical conditions, such as diabetes or peripheral neuropathy, is critical to preventing neuropathic ulcers.
• Lifestyle changes: Making lifestyle changes, such as quitting smoking, eating a healthy diet, and exercising regularly, can also help reduce the risk.

Prevention

Preventing neuropathic ulcers involves managing underlying medical conditions and adopting healthy lifestyle habits. Here are some tips for preventing neuropathic ulcers:

• Proper foot care: Regular foot inspections, cleaning, and moisturizing can help prevent minor injuries and infections from escalating into ulcers. It is also important to wear comfortable shoes that fit well and provide adequate support.
• Control blood sugar: For people with diabetes, controlling blood sugar levels can help prevent nerve damage that may lead to neuropathic ulcers.
• Regular check-ups: Regular check-ups with a healthcare professional can help identify and manage underlying medical conditions that increase ulcer risk.
• Healthy lifestyle habits: Making healthy diet and exercise choices and avoiding smoking can also help reduce the risk.
• Avoiding injuries: Taking steps to avoid foot injuries, such as wearing protective footwear and being cautious when walking on uneven surfaces, can help avoid injuring the foot.

Outlook

The outlook for people with neuropathic ulcers depends on the severity of the wound and any underlying medical conditions. With proper diagnosis and treatment, many people can expect to heal successfully and avoid complications. However, some ulcers may be challenging to treat and require long-term care.

Complications of neuropathic ulcers include infections, gangrene, and amputations. In some cases, these complications can be life threatening. Prompt diagnosis and treatment are essential to prevent complications and improve outcomes.

Summary

Neuropathic ulcers develop due to nerve damage in the foot, often in people with diabetes or spinal cord injuries. It causes a nonhealing wound, redness, pain, and inflammation.

Treating neuropathic ulcers can be challenging but may include wound care, offloading, medication, and surgery. The outlook for people with neuropathic ulcers depends on how severe the wounds are and any underlying conditions.