Contents

SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences

Information for Patients

View all Images (40)

Neurogenic ulcer
Other Resources UpToDate PubMed

Neurogenic ulcer

Contributors: Erin X. Wei MD, Susan Burgin MD, Lowell A. Goldsmith MD, MPH
Other Resources UpToDate PubMed

Synopsis

Neurogenic ulcers (also known as neuropathic and diabetic ulcers; mal perforans) are ulcerations on the pressure points of the foot caused by repetitive trauma. Neurogenic ulcers are typically found in individuals with peripheral neuropathy, diabetic peripheral neuropathy, anatomic deformities of the foot, Charcot neuroarthropathy, or peripheral artery disease. The pathogenesis is typically due to neuropathy but may be multifactorial (eg, neuropathy and peripheral artery disease). Secondary infection of the ulcer may prevent healing.

Neurogenic ulcers are most commonly seen in individuals with long-standing diabetes; it is one of the most common complications of diabetes mellitus (type 1, type 2) and affects approximately 19%-34% of individuals with diabetes during their lifetime. There is a recurrence rate of 60% in 3 years for individuals with diabetes. Twenty percent of neurogenic ulcer patients with diabetes will require amputation with a 70%, 5-year mortality after amputation. The presence of neurogenic ulcers in diabetic patients increases mortality by 2.5-fold. While the overwhelming majority of neurogenic ulcers occur in individuals with diabetes, other conditions can cause polyneuropathy (eg, alcohol use disorder, arsenic poisoning) or local neuropathy (eg, herpes zoster, Hansen disease) and can also be precipitating factors.

Neurogenic ulcers are difficult to treat, frequently recur, and result in significant morbidity in the form of loss of function and, often, loss of limb.

Codes

ICD10CM:
E13.621 – Other specified diabetes mellitus with foot ulcer
L97.509 – Non-pressure chronic ulcer of other part of unspecified foot with unspecified severity

SNOMEDCT:
15074003 – Neurogenic ulcer

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Keep in mind that many conditions that lead to skin ulceration may coexist within the same patient.
  • Stasis ulcer
  • Ischemic ulcer
  • Leukocytoclastic vasculitis
  • Pressure injury (decubitus ulcer)
  • Pyoderma gangrenosum
  • Acral lentiginous melanoma
  • Necrobiosis lipoidica
  • Calciphylaxis
  • Nodular basal cell carcinoma
  • Cutaneous squamous cell carcinoma / Marjolin ulcer
  • Pulmonary embolism
  • Drug-induced cutaneous necrosis (Warfarin necrosis, Heparin necrosis)
  • Acroosteolysis
  • Hereditary sensory and autonomic neuropathies

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Reviewed:10/25/2023
Last Updated:11/29/2023
Copyright © 2024 VisualDx®. All rights reserved.
Patient Information for Neurogenic ulcer
Print E-Mail Images (40)
Contributors: Medical staff writer
Premium Feature
VisualDx Patient Handouts
Available in the Elite package
  • Improve treatment compliance
  • Reduce after-hours questions
  • Increase patient engagement and satisfaction
  • Written in clear, easy-to-understand language. No confusing jargon.
  • Available in English and Spanish
  • Print out or email directly to your patient
Copyright © 2024 VisualDx®. All rights reserved.
Neurogenic ulcer
A medical illustration showing key findings of Neurogenic ulcer : Heel, Skin ulcer, Foot or toes, Plantar foot
Clinical image of Neurogenic ulcer - imageId=88325. Click to open in gallery.  caption: 'An ulcerated hyperkeratotic plaque on the distal sole.'
An ulcerated hyperkeratotic plaque on the distal sole.
Copyright © 2024 VisualDx®. All rights reserved.