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. As a result of an autonomic neuropathy the foot is often warm and peripheral pulses may be present. The treatment of diabetic ulceration is multi-disciplinary. Prevention is better than cure.
Prevention requires the identification of feet 'at risk' ideally in dedicated foot clinics.
Patients can be educated and advised on appropriate foot care. Such an approach has been shown to reduce amputation rates. Neuropathic ulcers require pressure relief and debridement of callus. Ischaemic ulcers require vascular assessment often including angiographic assessment down to the pedal vessels. Revascularisation often involves a distal bypass procedure.