What is the differencene between a neuropathic, neuroischaemic and ischaemic diabetic foot ulcer?
Diabetic neuropathy and peripheral arterial disease are the main underlying causes of diabetic foot ulceration.
Diabetic neuropathy plays a central role in the occurrence of a DFU. This neuropathy leads to an insensitive and sometimes deformed foot, often causing an abnormal walking pattern. Peripheral neuropathy may predispose the foot to ulceration through its effects on the sensory, motor and autonomic nerves.:
- Motor neuropathy can cause foot deformities (such as hammer toes and claw foot), which may result in abnormal pressures over bony prominence
- Tho loss of protective sensation experienced by patients with sensory neuropathy renders them vulnerable to physical, chemical and thermal trauma
- Autonomic neuropathy is typically associated with dry skin, which can result in fissures, cracking and callus⁽¹⁾
Peripheral artery disease (PAD) is an important risk factor for impaired wound healing and lower extremity amputation. A minority of foot ulcers are purely ischaemic; these are usually painful and caused by minor trauma.
The majority of foot ulcers are neuro-ischaemic, I.e., caused by combined neuropathy and ischaemia. In these patients, symptoms may be absent because of the neuropathy, despite severe pedal ischaemia. Diabetic microangiopathy is not likely to be the primary cause of an ulcer or poor wound healing DFUs (IWGDF guidelines 2015).
DID YOU KNOW? - What kind of patients are at risk of developing a DFU?
Typical foot ulcer patient profile⁽²⁾:
Male rather than female. elderly, overweight, tobacco user, Alcohol user, lower socio-economic level, neuropathy, peripheral arterial disease, other diabetes complications, commodities such as renal disease.
20.Armstrong, D. G., Cohen, K., Courric, S., Bharara, M., & Marston, W.(2011). Diabetic Foot Ulcers and Vascular Insufficiency: Our Population HasChanged, but Our Methods Have Not. Journal of Diabetes Science and Technology,5(6), 1591–1595.
1. WorldDiabetes Day 2015. Diabetes follow-up and burden of it’s severe complications,in France; BEH IVS N° 34-35 | 10 novembre 2015
2. BoultonAJ, Armstrong DG, Albert SF, et al. Comprehensive foot examinationand riskassessment. Diabetes Care 2008; 31: 1679-85.