Neuroischaemic ulcer

Ulceration in the neuroischaemic foot usually occurs on the margins of the foot. The first sign of ulceration is a red mark which blisters and then develops into a shallow ulcer with a base of sparse pale granulations or yellowish closely adherent slough. In ischaemia, there is often a halo of erythema around the ulcer where local blood vessels have dilated in an attempt to improve perfusion of the area (Fig. 4.1).

Pain associated with a neuroischaemic ulcer may be due to the ischaemia itself or to infection. The degree of pain will depend on the severity of concomitant neuropathy.

It is now necessary to classify the ulcer as neuropathic or neuroischaemic. This is achieved by:

• Taking a history

• Examination of the foot and the ulcer

• Investigations, including neurological and vascular status.

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