Occur as a result of peripheral neuropathy

Pathophysiology:

• Loss of (protective) sensation in peripheral neuropathy, leads to repetetive stress and unnoticed injuries forming = painless ulcer formation on pressure points in the limb
• concurrent vascular disease will often contribute to their formation and reduce healing potential

Risk factors:

• Any condition with peripheral neuropathy - Diabetes mellitus, B12 deficiency
• foot deformity
• concurrent peripheral vascular disease

Features

• Often painless ulcers with abnormal/diminished sensation
• Typically have a history of peripheral neuropathy
• Ulcers are variable in size and depth, occur at sites of pressure (MT head, heel)
• Additionally, there may be a peripheral neuropathy (classically in a ‘glove and stocking’ distribution) with warm feet and good pulses (unless element of concurrent arterial disease).

Investigations

Bedside:

• Concurrent arterial disease should be assessed with an ABPI +/- duplex.
• Extent of neuropathy – monofilament or vibration sensation