This photograph shows the typical ulceration seen on the tips of toes and on pressure bearing areas of the feet in a patient with diabetes mellitus. Lower limb amputation is fifteen times more common in diabetic than non-diabetic patients. The aetiology of the diabetic foot is multifactorial. Diabetic peripheral neuropathy results in sensory loss and undetected repeated minor trauma that predisposes to ulceration.
Diabetics also have an increased incidence of peripheral vascular disease.
Compared to the non-diabetic population they usually have a more peripheral distribution of this vascular disease. Microvascular disease and infection also contribute to ulceration. Ischaemic ulcer typically occur on the toes and heel. In the absence of significant neuropathy the feet are often cold with no palpable pulses. Neuropathic ulcers occur at sites of trauma and callus formation.