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The chronic and intractable character of the ulcer is due to interference with the trophic nerve-supply of the parts, and to the fact that the epithelium of the skin grows in and lines the track leading down to the deepest part of the ulcer and so prevents closure.
So the form of the infinite and universal energy, which we may call erg-dynamic, is the cause of the waste of the body through which it works; and this is at once made good by the increased trophic metabolism which occurs, to replace the waste this increased trophic metabolism showing itself in increased O2 intake and coincidently or correspondingly with increased CO2 output.
In all these forms there is impaired sensation, rarely amounting to anæsthesia, marked muscular wasting, and diminution or loss of voluntary motor power, while and this is a point of great importance the normal electrical reactions are preserved. There may also develop trophic changes such as blisters, superficial ulcers, and clubbing of the tips of the fingers.
The loss of sensibility depends upon whether the nerve is divided above or below the origin of the large cutaneous branch which comes off just before it passes round the neck of the fibula. In course of time the foot becomes inverted and the toes are pointed pes equino-varus and trophic sores are liable to form.
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