Probeability of the ulcer

The depth and dimensions of the ulcer are determined by probing, which is an important part of the examination. Probing reveals the presence of:

• Undermined edges where the probe can be passed from the ulcer under surrounding intact skin (Fig. 4.3a,b)

• Sinuses when the probe can be inserted deeper than in other areas of the ulcer bed and may reach tendon or bone. A sinus may not be immediately apparent, but

Fig. 4.3 (a) Ulcer with a probe placed over the skin to indicate position of sinus, (b) Probe inserted into sinus of same ulcer.

may be sometimes disclosed by probing suspicious areas of the ulcer, which are a different colour to the remainder of the ulcer bed. These areas may also be less firm and resilient.

Some ulcers appear to pout, or stand proud of the surrounding epithelium. If such an ulcer is producing copious amounts of discharge there will often be a sinus present. The aperture of the sinus may be slit-shaped rather than round (Fig. 4.4).

When probing the practitioner should determine the following:

• The depth and breadth of the ulcer

• The depth and direction of any sinus

• Does the probe reach bone? If so, this suggests osteomyelitis and the foot is at stage 4.

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