Semiquantitative analysis of the histopathological features of the neuropathic foot ulcer - Effects of pressure relief

OBJECTIVE - This study was designed to evaluate the histopathology of neuropathic ulcers and whether pressure relief could change such histological patterns. RESEARCH DESIGN AND METHODS - We compared neuropathic plantar ulcers tissue excised from 10 diabetic patients (group A) with those taken from 10 patients with comparable lesions and glycemic control after 20 days in a total contact cast (group B). Tissue specimens were blindly examined by two independent pathologists for hyperkeratosis, fibrosis, cutaneous annexes, capillaries, inflammation, cellular debris, and granulating tissue. For each parameter, quantification was obtained according to an arbitrary score: 0, absent; 1, present in <33%; 2, present in 34-66%; and 3, present in >67% of the lesion. RESULTS - Patients in group B showed a marked reduction in ulcer size after 20 days of casting (P < 0.01). The histopathological features of the two groups markedly differed. Group A patients showed a predominance of inflammatory elements as well as matrix alterations, vessel disruptions, inflammation, and debris. Group B ulcers showed a shift toward a reparative pattern with prevalence of neoformed capillaries and fibroblasts. Semiquantitative analysis confirmed. the prevalence of hyperkeratosis, fibrosis, inflammation, and cellular debris in group A patients (P < 0.05), whereas cutaneous annexes, capillaries, and granulating tissue were more prevalent in group B lesions (P < 0.01). CONCLUSIONS - These results indicate that pressure relief with a total contact cast is associated with changes in the histology of neuropathic foot ulcers, indicating reduction of inflammatory and reactive components and acceleration of reparative processes.