Neuropathic ulcers, common in diabetics, result from nerve damage and insufficient blood supply, leading to open sores. Treatment depends on the type and depth of the ulcer.
Neuropathic ulcers, also called mal perforans, generally involve open sores that go unnoticed because damaged nerves are unable to receive or transmit pain signals. Skin lesions usually develop as a result of an insufficient blood supply. The condition commonly affects diabetics, but could be acquired by individuals with high lipids, high blood pressure, or vascular disorders. Treatment of a neuropathic ulcer generally depends on the type and location of the damaged tissue.
Nerve damage related to a neuropathic ulcer frequently occurs in individuals with uncontrolled diabetes. Some doctors suggest that constant hyperglycemia traps high levels of sorbitol and other chemicals in the body. The chemical imbalance interferes with the ability of nerve tissue to conduct and transmit pain signals to the brain. Over a long period of time, nerve cells die in this toxic environment. Without the ability to experience discomfort or pain normally, patients may not notice skin abnormalities until open sores develop.
Vascular blockage usually perpetuates the neuropathic ulcer. Without adequate blood circulation, tissues do not receive adequate nutrition, nor can they eliminate waste products. Eventually cell death occurs and it develops in open areas in the skin. Inhibition of circulation can occur when weight-bearing areas are subjected to constant pressure or in the presence of vascular disease. For this reason, diabetic patients must carefully maintain and frequently inspect all areas of the feet.
A venous or arterial insufficiency ulcer usually develops in the lower legs. Insufficiency is often the result of plaque buildup caused by chronic elevations in blood cholesterol or triglycerides. The condition commonly occurs in diabetic patients, but can affect others as well, if inadequate circulation contributes to nerve damage due to lack of sensation. Individuals who experience a circulation impediment generally develop ulcers below the site of the blocked vessel.
Doctors can diagnose a neuropathic ulcer by evaluating blood sugar and glycosylated hemoglobin along with cholesterol and triglycerides. In addition to evaluating possible nerve damage, doctors also determine circulation levels through vascular studies. When ill-fitting shoes or orthopedic abnormalities cause a neuropathic ulcer, the patient should correct the underlying cause in addition to receiving ulcer treatment.
Diabetics with consistently high blood sugar levels usually require medication adjustments. These changes not only prevent future ulcers, but also improve the body’s ability to heal. Treatment for a neuropathic ulcer also varies with the depth of the open area. A newly formed ulcer that is not very deep may only require a protective dressing. Deeper wounds that include muscle tissue or tunneling elsewhere may require removal of dead tissue or surgical repair.
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