What a neuropathic foot ulcer is
A neuropathic foot ulcer is an open sore on a foot that has lost some or all of its normal feeling. Neuropathic foot ulcer care starts from that fact: the wound formed because the foot could not warn you. Pressure, rubbing or a small injury went on longer than healthy nerves would have allowed.
Clinicians call this warning system protective sensation. With it, a pebble in your shoe makes you stop. Without it, you can walk on that pebble all day. The skin breaks down, often under a thick callus on the ball of the foot, the heel or the tip of a toe.
If you are looking for help with this wound close to home, start with our overview of wound care in St. Louis.
Causes of nerve damage beyond diabetes
Diabetes is the most common cause of nerve damage in the feet, and we cover it on the diabetic foot ulcer page. It is not the only one. Peripheral neuropathy, the medical name for this nerve damage, has many causes:
- Long-term heavy alcohol use
- Low vitamin B12
- Nerve damage from certain chemotherapy medicines
- Chronic kidney disease
- Spinal cord injury, spina bifida and other spine or nerve conditions
- Inherited nerve conditions
- Neuropathy with no cause found
Your primary care clinician or a neurologist usually leads the search for a cause, while the wound care team focuses on the ulcer.
Why neuropathic ulcers are easy to miss
Most wounds hurt. A neuropathic ulcer often does not, so people find it by accident: a stain on a sock, a smell, a callus with a dark spot under it, or a foot that looks swollen or feels warm to the hand.
Nerve damage also changes the foot. Toes can curl, the arch can change shape, and dry skin can crack, creating new pressure points. A numb foot that turns red, warm and swollen without a clear reason needs prompt attention, because its bones and joints can weaken and shift (a condition called Charcot foot).
What the treating clinician looks at
The treating clinician examines the whole foot, not only the sore. The review usually covers:
- The size and depth of the ulcer and the callus around it
- Signs of infection, and whether the wound may reach deeper tissue or bone
- Blood flow to the foot, since circulation problems often occur along with neuropathy
- How much feeling remains in each foot
- Foot shape, your shoes and how you walk
- Blood sugar, nutrition and other conditions that affect healing
From this, the clinician decides on treatment and writes the orders. That may include removing callus or unhealthy tissue, choosing dressings, ordering tests, or referring you to a podiatrist or vascular specialist.
Offloading takes pressure off the wound
A neuropathic ulcer rarely heals while you keep walking on it the same way. Offloading means moving pressure away from the wound so the tissue can recover. Depending on the wound, the clinician may order a cast, a special boot or shoe, padding, or limits on standing and walking.
Offloading only works when it fits your life, so tell the clinician about stairs, balance concerns and your daily routine. Our guide to what offloading is explains the common options, and Gateway can help coordinate offloading for foot wounds once it has been ordered.
Changes to report and when to call 911
Because the foot may not hurt, your eyes and hands do the work the nerves cannot. Tell the treating clinician promptly if you notice:
- New redness, warmth or swelling in the foot or lower leg
- More drainage, a new odor, pus or other signs of wound infection
- The wound getting larger or deeper, or skin turning dark
- Fever or chills
- A new blister, crack or sore anywhere on either foot
Call 911 for an emergency, such as confusion, trouble breathing, fainting, bleeding that will not stop, or a foot that suddenly turns cold, pale or blue. Gateway is not an emergency service.
How Gateway arranges neuropathic foot ulcer care
Gateway connects people across Greater St. Louis and the Metro East with partner clinicians who provide wound care in homes, skilled nursing facilities, assisted living and other settings. For someone told to stay off a foot, wound care at home can mean less walking to and from appointments.
We handle records, scheduling, supply and equipment orders, and updates to your podiatrist, primary care clinician and other specialists. The treating clinician makes every clinical decision.
Call 314-325-0126 with or without a referral, or request care online. The form asks only for a name and phone number. Visit availability is confirmed by location and care setting, and coverage depends on the treating provider, your plan and the care needed.
Common questions
Can I get a neuropathic foot ulcer if I do not have diabetes?
Yes. Any condition that damages the nerves in the feet can lead to one, and sometimes no cause is found. If you have numbness, tingling or burning in your feet and no diagnosis, bring it up with your primary care clinician.
Why does my foot ulcer not hurt?
The same nerve damage that let the ulcer form also dulls pain from the wound, so a painless ulcer is not a minor one. Some people feel burning or shooting nerve pain and still cannot feel pressure or injury. If a numb wound starts to hurt, report it, because new pain can be a sign of infection.
Is it safe to keep walking on a neuropathic foot ulcer?
Ask the treating clinician before you assume it is. Each step puts pressure on the wound, and you may not feel the harm. The clinician will tell you how much walking is appropriate and what to wear. Our guide on moving safely with a foot wound lists questions to ask.
Can the ulcer come back after it heals?
It can. The nerve damage and pressure points that caused the first ulcer usually remain after the skin closes. Clinicians often recommend daily foot checks, properly fitted footwear and regular foot exams after healing. Ask what follow-up schedule makes sense for you.
Related pages
General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.