What causes diabetic ulcers?
Diabetic ulcers occur on the feet secondary to peripheral neuropathy and peripheral vascular disease. There are several different causes of peripheral neuropathy.
Diabetic neuropathy, which is the most common, occurs as a result of hypoglycemia, hyperglycemia and insulin deficiency. The neurological deficits can lead to altered sensory, motor and/or autonomic alterations of the feet.
Sensory neuropathy, another type of neuropathy, is the loss of protective sensation and can cause numbness, impaired temperature perception and inability to feel pain. This puts diabetics at high risk for ulceration since they cannot detect if a foot is experiencing damage from things such as an ill-fitting shoe or a rock in their shoe.
Meanwhile, motor neuropathy leads to motor loss, muscle weakness, muscle atrophy and anatomical manifestations (e.g. foot drop, claw toes). This puts diabetics at risk for tripping, unstable gait and falls. The anatomical manifestations change the shape of the foot, making it difficult to find properly fitting footwear, leading to wounds of the feet.
And autonomic neuropathy leads to the feet having decreased vasomotor activity with anhidrosis (inability to sweat normally). The anhidrosis makes diabetics susceptible to wounds on their feet due to the skin becoming flaky, thinning and peeling. Some parts may callus, leading to cracks and fissures. Autonomic neuropathy affects the circulation to the foot, which can lead to the tissue dying, thus causing a wound.
Diabetic ulcers often are mislabeled as pressure injuries since pressure contributes to their formation. However, the underlying etiology is the neuropathy. Proper diagnosis is imperative, as diabetic neuropathy wounds are at high risk for nonhealing, infection and amputation.
From the December 2019 Issue of McKnight's Long-Term Care News
