What Is a Neuropathic Ulcer?

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  • Written By: Maggie J. Hall
  • Edited By: Susan Barwick
  • Last Modified Date: 15 October 2019
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Neuropathic ulcers, also called mal perforans, generally involve open sores that go unnoticed because damaged the nerves are unable to receive or transmit pain signals. The skin lesions usually develop secondary to an insufficient blood supply. The condition commonly affects diabetics, but might be acquired by individuals with elevated lipids, hypertension, or vascular disorders. Treating 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 having uncontrolled diabetes. Some physicians suggest that consistent hyperglycemia traps high levels of sorbitol and other chemicals in the body. The chemical imbalance interferes with the nerve tissue’s ability to conduct and transmit pain signals to the brain. Over an extended period of time, in this toxic environment, nerves cells die. With no capacity to feel 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 wastes. Eventually cell death occurs and develops into open areas in the skin. Inhibited circulation may 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 on the lower legs. The insufficiency is often the result of plaque buildup caused by chronic elevations of blood cholesterol or triglycerides. The condition commonly occurs in diabetic patients, but can also affect others, if inadequate circulation contributes to nerve damage because of the lack of sensation. Individuals who experience a circulation impediment generally develop ulcers below the site of the blocked vessel.

Physicians may diagnose a neuropathic ulcer by evaluating blood glucose and glycosylated hemoglobin along with cholesterol and triglycerides. Besides assessing possible nerve damage, physicians also determine circulation levels by means of vascular studies. When ill-fitting shoes or orthopedic abnormalities cause a neuropathic ulcer, the patient must correct the underlying cause in addition to receiving ulcer treatment.

Diabetics with consistently elevated blood sugar levels usually require medication adjustments. These changes not only prevent future ulcerations but also enhance the body’s healing ability. 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 dead tissue removal or surgical repair.


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