ABSTRACT
INTRODUCTION The management of foot ulceration in patients with diabetes mellitus remains a complicated matter. This is related to the complex pathogenesis of these skin injuries (1). Neuropathic, ischemic, as well as biomechanical factors act together to cause trauma of both the plantar and dorsal foot surfaces. Most plantar foot ulcers occur in the forefoot and toe areas (2). The principle factors in the development of these plantar lesions are loss of protective sensation caused by peripheral neuropathy in combination with mechanical trauma caused by the repetitive application of increased levels of foot pressure (3,4). Accordingly, the site of a foot ulcer most often corresponds with the site of the highest measured plantar pressure (5). These elevated plantar pressures are associated with the presence of foot deformities, such as claw toes and Charcot midfoot deformity, and other structural abnormalities, such as limited joint mobility, abundant callus formation, and prominent metatarsal heads (4,6-8). Therefore, proper management of plantar diabetic foot ulcers should include interventions that accommodate these structural abnormalities and that reduce plantar pressures at the site of ulceration.
