Neuroischaemic foot

Ulcers in neuroischaemic feet usually develop around the margins of the foot. Revascularization is the definitive

Fig. 4.10 (a) Bullae over lesser toes caused by footwear, (b) The bullae are dry and healing well after 2 weeks.

treatment, although it is still important to off-load the ulcer. A high-street shoe that is sufficiently long, broad and deep, and fastens with a lace or strap high on the foot, may be all that is needed to protect the vulnerable margins of the foot and allow healing. Neuroischaemic ulcers may be prevented from healing because the patient wears tight shoes or slip-on styles.

It may be necessary to provide special footwear. In the first instance, a temporary shoe such as a Darco may be used if dressings are bulky. Alternatively, a ready-made stock shoe which is wide fitting may be suitable. The Scotchcast boot may also be used, when ulcers are large, for postsurgical feet or for feet which fail to respond to treatment in footwear. Crutches and Zimmer frames may be useful for the neuroischaemic patient as described above for the neuropathic patient.

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