Treating wounds associated with decreased sensibility

Neuropathic wounds are a problem most often associated with diabetes, particularly in those patients with decreased sensibility. More often than not, the patient is unaware of the insidious progression of dysfunction and its direct impact on tissue necrosis. Even when the underlying cause is discovered, often no mechanism is present to compensate for the loss of sensory protection. Current pharmacologic treatment for peripheral neuropathy is palliative with capsaicin and amitriptyline, used most frequently to treat symptoms of painful peripheral neuropathy. Orthotists and prosthetists are helpful in developing shoes or support devices to provide relief or lifts from weight-bearing areas in the insensate patient. Proper patient education and primary-care monitoring can greatly decrease the number of non-heating foot lesions and amputations.