ABSTRACT

Diabetic foot ulcerations are characterized by a delay in healing. The risk factors for diabetic foot ulceration can be categorized into three distinct groups: pathophysiologic changes, anatomic deformities, and environmental influences. Pathophysiologic changes at the biomolecular level lead to peripheral sensory neuropathy, peripheral vascular disease, and a compromised immune system with alteration in wound-healing capabilities. In cases of severe neuropathy, the forefoot pressures are so high that the ratio between forefoot and rear foot pressures is increased and can be used as an alternative of foot pressure measurement in identifying the at-risk patient for foot ulceration. Treatment of the diabetic foot ulcer should be individually tailored according to the size, depth, location, and presence/absence of infection or ischemia. Location of the ulcer will give clues as to the etiology of the wound, whether it is due to shoe pressure or an osseous prominence.