Most primary ulcers are the result of direct trauma. The first ulcer may follow an obvious accident a step on a stone or a puncture by a nail, but because of NO PAIN the lesion is neglected and the ulcer becomes chronic. A person with normal sensation would alter their gait to prevent pain when walking on the ulcer, but the patient with sensory neuropathy will continue to walk as if nothing was wrong. The more chronic the ulcer, or the slower it heals, the more scar tissue will be left when it does heal. Scar tissue is more prone to ulceration than normal skin.
Scarred skin is ulcer liable.
One ulcer leads to another unless actively prevented. Any ulcer on the weightbearing surface of a foot should be completely rested until it is healed. Splint and crutches to rest and protect the damaged limb. The patient can get around on crutches, but there is no weight on the wound and he is not traumatizing it by rubbing on the bed or bumping it. The use of a contact walking plaster cast.