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Diabetic Ulcers Differential Diagnoses

Author: Vincent Lopez Rowe, MD; Chief Editor: Vincent Lopez Rowe, MD more...

Updated: Sep 27, 2011

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Diagnostic Considerations

The classic diabetic trophic ulcer must be distinguished from various other problems that tend to occur in persons with diabetes, such as diabetic dermopathy, bullosis diabeticorum, eruptive xanthoma, necrobiosis lipoidica, and granuloma annulare.

The leg pain of peripheral arterial disease must be distinguished from other causes of leg pain, such as arthritis, muscle pain, radicular pain, spinal cord compression, thrombophlebitis, anemia, and myxedema.

Diabetic neuropathy should be distinguished from other forms of neuropathy, including vasculitic neuropathies, metabolic neuropathies, autonomic neuropathy, radiculopathy, and many others.

Differential Diagnoses

Proceed to Workup

Contributor Information and Disclosures

Author

Vincent Lopez Rowe, MD Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey Lawrence Kaufman, MD Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine

Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society for Artificial Internal Organs, Association for Academic Surgery, Association for Surgical Education, Massachusetts Medical Society, Phi Beta Kappa, and Society for Vascular Surgery

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Vincent Lopez Rowe, MD Associate Professor of Surgery, Department of Surgery, Division of Vascular Surgery, University of Southern California Medical Center

Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Heart Association, Pacific Coast Surgical Association, Peripheral Vascular Surgery Society, Society for Clinical Vascular Surgery, Society for Vascular Surgery, and Western Vascular Surgical Society

Disclosure: Nothing to disclose.

References

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Diabetic ulcer of the medial aspect of left first toe before and after appropriate wound care.

Diabetic ulcer of left fourth toe associated with mild cellulitis.

Charcot deformity with mal perforans ulcer of plantar midfoot.

Table. Characteristics and Uses of Wound Dressing Materials

Table. Characteristics and Uses of Wound Dressing Materials

Category	Examples	Description	Applications
Alginate	AlgiSite Comfeel Curasorb Kaltogel Kaltostat Sorbsan Tegagel	This seaweed extract contains guluronic and mannuronic acids that provide tensile strength and calcium and sodium alginates, which confer an absorptive capacity. Some of these can leave fibers in the wound if they are not thoroughly irrigated. These are secured with secondary coverage.	These are highly absorbent and useful for wounds having copious exudate. Alginate rope is particularly useful to pack exudative wound cavities or sinus tracts.
Hydrofiber	Aquacel Aquacel-Ag Versiva	An absorptive textile fiber pad, also available as a ribbon for packing of deep wounds. This material is covered with a secondary dressing. The hydrofiber combines with wound exudate to produce a hydrophilic gel. Aquacel-Ag contains 1.2% ionic silver that has strong antimicrobial properties against many organisms, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus.	These are absorbent dressings used for exudative wounds.
Debriding agents	Hypergel (hypertonic saline gel) Santyl (collagenase) Accuzyme (papain urea)	Various products provide some degree of chemical or enzymatic debridement.	These are useful for necrotic wounds as an adjunct to surgical debridement.
Foam	LYOfoam Spyrosorb Allevyn	Polyurethane foam has some absorptive capacity.	These are useful for cleaning granulating wounds having minimal exudate.
Hydrocolloid	Aquacel CombiDERM Comfeel Duoderm CGF Extra Thin Granuflex Tegasorb	These are made of microgranular suspension of natural or synthetic polymers, such as gelatin or pectin, in an adhesive matrix. The granules change from a semihydrated state to a gel as the wound exudate is absorbed.	They are useful for dry necrotic wounds, wounds having minimal exudate, and clean granulating wounds.
Hydrogel	Aquasorb Duoderm IntraSite Gel Granugel Normlgel Nu-Gel Purilon Gel (KY jelly)	These are water-based or glycerin-based semipermeable hydrophilic polymers; cooling properties may decrease wound pain. These gels can lose or absorb water depending upon the state of hydration of the wound. They are secured with secondary covering.	These are useful for dry, sloughy, necrotic wounds (eschar).
Low-adherence dressing	Mepore Skintact Release	These are various materials designed to remove easily without damaging underlying skin.	These are useful for acute minor wounds, such as skin tears, or as a final dressing for chronic wounds that have nearly healed.
Transparent film	OpSite Skintact Release Tegaderm Bioclusive	These are highly conformable acrylic adhesive film having no absorptive capacity and little hydrating ability, and they may be vapor permeable or perforated.	These are useful for clean dry wounds having minimal exudate, and they also are used to secure an underlying absorptive material. They are used for protection of high-friction areas and areas that are difficult to bandage such as heels (also used to secure IV catheters).

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