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Neurotrophic ulcers
Last reviewed: 07.07.2025
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Neurotrophic ulcers occur in patients with lesions of the central or peripheral nervous system. They most often occur in patients with the neuropathic form of diabetic foot syndrome, CNS and peripheral nerve injuries. When excluding diabetes mellitus and traumatic lesions of the nervous system, differential diagnostics should be carried out for diseases accompanied by sensory peripheral neuropathy. These include myelodysplasia, myelomeningocele, syringomyelia, leprosy, multiple sclerosis, amyotrophic lateral sclerosis, tabes dorsalis (tertiary syphilis), etc. The leading mechanisms of their development are considered to be impaired sensitivity and constant or prolonged compression and traumatization of tissues, leading to their destruction. In this regard, neurotrophic ulcers in most cases occur on the supporting surfaces of the limb: the sole, the heel area, on the lateral surfaces of the first and fifth metatarsophalangeal joints, in the ankle area.
Neurotrophic ulcers are round in shape, covered with dense fibrin deposits, flaccid granulations, weakly exude, are surrounded by a dense skin ridge with signs of pronounced hyperkeratosis, and are slightly painful.
They have a weak tendency to heal on their own. It is necessary to create conditions that completely exclude mechanical load on the area of trophic disorders, for which they use full or partial unloading of the foot with walking on crutches, the use of orthopedic insoles and shoes, the application of a removable plaster boot with a hole for care.
It should be noted that attempts at conservative treatment of neurotrophic ulcers in more than 70% of cases do not bring the desired result, and the frequency of their malignancy reaches 10%. If conservative therapy is ineffective, various methods of plastic surgery with full-layer skin flaps are used: plastic surgery with a rotational skin flap, VY plastic surgery, Italian skin plastic surgery, free transplantation of a complex of tissues on microvascular anastomoses, etc. Neurotrophic ulcers often recur while neuropathy persists.
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