1. Section Editor(s): Hess, Cathy Thomas BSN, RN, CWOCN

Article Content

An overview of chronic wound characteristics.



Predisposing Factors/Cause

Diabetic patient with peripheral neuropathy and/or peripheral vascular disease


Location and Depth

Any sites on the foot and lower limb subjected to repetitive pressure, friction, shear, or trauma; plantar aspect, metatarsal heads (especially first and fifth), great toe, heel; shallow to deep, may have tracking and/or undermining


Wound Bed and Wound Appearance

Granular tissue unless peripheral vascular disease is present; often has deep necrotic area; may be dry; cellulitis or osteomyelitis may be present; neuropathic ulcers almost always accompanied by eschar and often accompanied by exposed tendons



Low to moderate exudate; infected ulcer may have purulent drainage


Wound Shape and Margins

Smooth, even; may be small at the surface with large subcutaneous abscess, characterized by callus around the ulcer and undermined edges


Surrounding Skin

Dry, thin, frequently callused; periwound hyperkeratosis is common and indicates continued pressure



No sensation, or constant or intermittent numbness or burning; neuropathic ulcers are almost always accompanied by numbness and paresthesia



Patient must comply with diet, glucose regulation, exercise, and foot care/wear; aggressive revascularization and appropriate antibiotics may be needed for healing; custom or specialized shoes will reduce pressure and help prevent recurrence



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