Malum perforans
| Classification according to ICD-10 | |
|---|---|
| L97 | Leg ulcer, not elsewhere classified |
| ICD-10 online (WHO version 2019) | |
The malum perforans is an ulcer or callus on the sole of the foot as a result of a polyneuropathy . The polyneuropathy is mostly caused by diabetes mellitus , which is then also referred to as diabetic foot syndrome . In contrast to ulcus cruris, there is no significant circulatory disorder.
causes
Since a polyneuropathy is a prerequisite for the development of a malum perforans , all diseases that can cause peripheral nerve damage can be considered as the cause. By far the most common is diabetes mellitus, but alcohol abuse or a vitamin B12 deficiency can also be the cause. In addition to idiopathic polyneuropathy (with no apparent cause), even rarer diseases from the infectious or autoimmunological spectrum can be considered.
Pathogenesis
Due to the damage to the nerves on the feet, the patients do not receive any feedback about the stress on the feet when walking, which leads to incorrect stress. Calluses form in places where the bone is only protected with little fatty tissue and which are particularly stressed when walking. The perception of pain is also reduced due to the peripheral nerve damage, so that small injuries are not noticed on these pressure-loaded skin areas and an ulcer can quickly form on previously damaged skin.
Complications
The often existing microangiopathy makes it very difficult for cells from the blood to reach the tissue. Thus, on the one hand, the repair of the skin defect is made more difficult, on the other hand, cells of the immune system have difficulty reaching the open skin area, which potentially represents the entry point for a large number of pathogens. Without proper treatment, the ulcers can quickly spread to the bone and in the worst case infect it ( osteomyelitis ), which often leads to the amputation of part of the limb.
treatment
First and foremost is the treatment of the underlying disease on which the polyneuropathy is based. Professional foot care and relieving footwear should be mandatory. Necrotic parts of the ulcer should be removed and the wound should be kept moist under bandages. In the case of infected ulcers, antibiotic therapy must be considered; if the bone is already infected, often only the extremity can be amputated.
Web links
Individual evidence
- ^ J. Paton et al .: Effectiveness of insoles used for the prevention of ulceration in the neuropathic diabetic foot: a systematic review. In: J Diabetes Complications. 2009 Oct 22.
- ↑ RJ Snyder, JR Hanft: Diabetic Foot Ulcers - Effects on QOL, Costs, and Mortality and the Role of Standard Wound Care and Advanced Care Therapies. In: Ostomy Wound Management. 2009; 55 (11).
- ↑ K. Cheer et al .: Managing complications of the diabetic foot. In: BMJ. 2009 Dec 2; 339, p. B4905.
