ABC of wound healing: Diabetic foot ulcers
Diabetic foot ulcers can be divided into two groups: those in neuropathic feet (so called neuropathic ulcers) and those in feet with ischaemia often associated with neuro-pathy (so called neuroischaemic ulcers). The neuropathic foot is warm and well perfused with palpable pulses; sweating is diminished, and the skin may be dry and prone to fissuring. The neuroischaemic foot is a cool, pulseless foot; the skin is thin, shiny, and without hair. There is also atrophy of the subcutaneous tissue, and intermittent claudication and rest pain may be absent because of neuropathy.
The crucial difference between the two types of feet is the absence or presence of ischaemia. The presence of ischaemia may be confirmed by a pressure index (ankle brachial pressure index <1). As many diabetic patients have medial arterial calcification, giving an artificially raised ankle systolic pressure, it is also important to examine the Doppler arterial waveform. The normal