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Neuropathic Ulcers

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Ulcers of the Lower Extremity

Abstract

The most common cause of neuropathic ulceration to the lower limb is diabetes mellitus [1]. Primary neurological conditions (including multiple sclerosis and paraplegia), renal failure, chronic liver disease, alcohol excess, nutritional deficiencies, HIV, trauma, and surgery can also lead to peripheral neuropathy and hence to ulceration. Less common conditions that can result in neuropathic ulcers include chronic leprosy, spina bifida, syringomyelia, tabes dorsalis, poliomyelitis, and hereditary sensory and motor neuropathy (HSMN) commonly called Charcot-Marie-Tooth (CMT) disease [2, 3].

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References

  1. London NJ, Donnely R. ABC of arterial and venous disease. Ulcerated lower limb. BMJ. 2000;320:1589–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Spentzouris G, Labropoulos N. The evaluation of lower-extremity ulcers. Semin Intervent Radiol. 2009;26(4):286–95.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Khachemoune A, Kauffman C. Diagnosis of leg ulcers. Internet J Dermatol. 2001;1(2):1–7.

    Google Scholar 

  4. Ndip A, Rutter MK, Vileikyte L, Vardhan A, Asari A, Jameel M, Tahir HA, Lavery LA, Boulton AJM. Dialysis treatment is an independent risk factor for foot ulceration in patients with diabetes and stage 4 or 5 chronic kidney disease. Diabetes Care. 2010;33:1811–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Diabetes UK. State of the nation 2012 – England. [Internet] London: Diabetes UK; 2012. http://www.diabetes.org.uk/About_us/What-we-say/Improving-services--standards/State-of-the-Nation-2013/. Accessed May 2013.

  6. Haria JM, Singh VK, Jain SK. Life with diabetic foot ulcer – a cross sectional study. Int J Sci Study. 2014;1(6):33–5.

    Google Scholar 

  7. Abetz L, Sutton M, Brady L, et al. The diabetic foot ulcer scale: a quality of life instrument for use in clinical trials. Pract Diab Int. 2002;19:167–75.

    Article  Google Scholar 

  8. Ndip A, Jude EB. Emerging evidence for neuroischaemic diabetic foot ulcers: model of care and how to adapt practice. Int J Low Extrem Wounds. 2009;8(2):82–94.

    Article  PubMed  Google Scholar 

  9. Kerr M. Foot care for people with diabetes: the economic case for change. Newcastle-upon-Tyne: NHS Diabetes; 2012. www.diabetes.org.uk/Documents/nhs-diabetes/footcare/footcare-for-people-with-diabetes.pdf. Accessed May 2014.

  10. Leslie CA, Sapico FL, Ginunas VJ, Adkins RH. Randomized controlled trial of topical hyperbaric oxygen for treatment of diabetic foot ulcers. Diabetes Care. 1988;11(2):111–6.

    Article  CAS  PubMed  Google Scholar 

  11. Bloomgarden ZT. Clinical diabetic neuropathy. Diabetes Care. 2005;28(12):2968–74.

    Article  PubMed  Google Scholar 

  12. Brownrigg JR, Davey J, Holt PJ, et al. The association of ulceration of the foot with cardiovascular and all-cause mortality in patients with diabetes: a meta-analysis. Diabetologia. 2012;55(11):2906–12.

    Article  CAS  PubMed  Google Scholar 

  13. Reiber GE, Viliekyte L, Boyko EJ. Causal pathways for incident lower extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22(1):157–62.

    Article  CAS  PubMed  Google Scholar 

  14. American Diabetes Association. Consensus Development Conference on diabetic foot wound care. Diabetes Care. 1999;22:1354–60.

    Article  Google Scholar 

  15. Edmonds ME, Foster AVM. ABC of wound healing, diabetic foot ulcers. BMJ. 2006;332:407–10.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Shaw JE, Boulton A. The pathogenesis of diabetic foot problems: an overview. Diabet Med. 1996;13 Suppl 1:812–6.

    Google Scholar 

  17. Mulder G, Armstrong D, Seaman S. Standard, appropriate, and advanced care and medical-legal considerations: part one — diabetic foot ulcerations. Wounds. 2003;15(4):92–106.

    Google Scholar 

  18. Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment. Diabetes Care. 2008;31:1679–85.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mueller MJ, Hastings MK, Commean PK, Smith KE, Pilgram TK, Robertson D, Johnson J. Forefoot structural predictors of plantar pressures during walking in people with diabetes and peripheral neuropathy. J Biochem. 2003;36:1009–17.

    Google Scholar 

  20. Krishnan S, Nash F, Baker N, et al. Reduction in diabetic amputations over 11 years in a defined UK population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care. 2008;31(1):99–101.

    Article  PubMed  Google Scholar 

  21. National Institute for Health and Clinical Excellence. Diabetic foot problems: inpatient management of diabetic foot problems. Clinical guideline 119. London: NICE; 2011. http://publications.nice.org.uk/diabetic-foot-problems-cg119. Accessed May 2014.

  22. International Best Practice Guidelines. Wound management in diabetic foot ulcers. Wounds International; 2013. www.woundsinternational.com.

  23. Wu S, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65–76.

    PubMed  PubMed Central  Google Scholar 

  24. Lipsky BA, Berendt AR, Cornia PB. Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. IDSA guidelines. Clin Infect Dis. 2012;54(12):132–73.

    Article  Google Scholar 

  25. Lipsky BA, Berendt AR, Deery HG, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004;39:885–910.

    Article  PubMed  Google Scholar 

  26. Wounds UK. Effective debridement in a changing NHS: a UK consensus. London: Wounds UK; 2013. www.wounds-uk.com. Accessed May 2014.

  27. Gottrup F, Jorgensen B. Maggot debridement: an alternative method for debridement. Eplasty. 2011;11:e33.

    PubMed  PubMed Central  Google Scholar 

  28. Haycock S, Chadwick P. Debridement of diabetic foot wounds. Nurs Stand. 2012;26(24):51–8.

    Article  Google Scholar 

  29. Ndip A, Ebah L, Mbako A. Neuropathic diabetic foot ulcers – evidence-to-practice. Int J Intern Med. 2012;5:129–34.

    Google Scholar 

  30. Hinchliffe RJ, Valk GD, Apelqvist J, et al. A systematic review of the effectiveness of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2008;24 Suppl 1:S119–44.

    Article  PubMed  Google Scholar 

  31. Kranke P, Bennett M, Roeckl-Wiedmann I, Debus S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2004;2:CD004123.

    Google Scholar 

  32. Cavanagh PR, Bus SA. Off-loading the diabetic foot for ulcer prevention and healing. J Vasc Surg. 2010;52:37s–43.

    Google Scholar 

  33. Scottish Intercollegiate Guidelines Network. Management of diabetes. A national clinical guideline. Guideline no 116. Edinburgh: SIGN; 2010. http://www.sign.ac.uk/pdf/sign116.pdf. Accessed May 2014.

  34. Armstrong DG, Lavery LA, Nixon BP, et al. It’s not what you put on, but what you take off: techniques for debriding and off-loading the diabetic foot wound. Clin Infect Dis. 2004;39 suppl 2:S92–9.

    Article  PubMed  Google Scholar 

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Correspondence to Agbor Ndip .

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© 2016 Springer India

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Ndip, A., Sadler, K., Lower, N. (2016). Neuropathic Ulcers. In: Khanna, A., Tiwary, S. (eds) Ulcers of the Lower Extremity. Springer, New Delhi. https://doi.org/10.1007/978-81-322-2635-2_13

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  • DOI: https://doi.org/10.1007/978-81-322-2635-2_13

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