Practical podiatry : . s and injuries to the peripheral nerves. Thislatter, known as the*mixed theory, is theone most generally ac-credited and is in allprobability most correct. This type of ulcer isfound more frequently inmales than in femalesand it occurs almost ex-clusively in adult life(between 40 and 60years). Occupation is apredisposing factor, andwork demanding longperiods of standing orwalking unquestionablyhas much to do with thedevelopment of a perfor-ating ulcer, all otherconditions being equal. Characteristics. Theulcer is usually found tobe irregularly circular inshape, with a te
Practical podiatry : . s and injuries to the peripheral nerves. Thislatter, known as the*mixed theory, is theone most generally ac-credited and is in allprobability most correct. This type of ulcer isfound more frequently inmales than in femalesand it occurs almost ex-clusively in adult life(between 40 and 60years). Occupation is apredisposing factor, andwork demanding longperiods of standing orwalking unquestionablyhas much to do with thedevelopment of a perfor-ating ulcer, all otherconditions being equal. Characteristics. Theulcer is usually found tobe irregularly circular inshape, with a tendency toprogressive development, involving the deeper soft tissues,finally attacking the periosteum and the bone itself, causingnecrosis. The superficial edges of the ulceration are heavilycalloused and the lesion shows little or no tendency to of the most marked characteristics is the entire loss ofsensation. Many cases have been observed where thepatient feels no pain, even when the lesion is deeply POST-OPERATIVE DIABETIC ULCER 326 PODIATRY Symptoms. At times, particularly in diabetic patients,a purulent blister is the initial lesion, but in most instancesthese lesions develop under a heavy callous, the centre ofwhich breaks down into an indolent superficial ulceration,discharging a thin, discolored, odorous pus, but never ingreat quantities. The fact that changes in the peripheral nerve supplyusually take place in the development of perforating ulcerprobably accounts for the absence of pain, as above men-tioned, and also explains the progressive degenerationwhich takes place, allowing the ulcerative process to prog-ress into the deeper tissues. Treatment. The systemic disturbances which may bepresent are important factors to be considered in the treat-ment of perforating ulcer, but local applications may bemade and local conditions must be considered. If the ulcerbe upon the plantar surfaces of the foot, walking and stand-ing, which would bring continued
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