ABSTRACT
Bony deformities increase the risk of foot ulceration several folds in a neuropathic foot. They result as a consequence of sensory and motor neuropathy. Deformities lead to bony prominences, areas of high localized pressure, and the total weight bearing area of the foot is reduced. The overlying or underlying skin is subjected to a high mechanical pressure. In neuropathic foot, the response to high pressure is hyperkeratosis and callus formation with eventual ulceration, whereas in neuroischemic foot, pressure leads to direct tissue damage and ulceration. Even callus requires a good blood supply to grow, thus explaining its flourishing growth in neuropathic foot as compared to neuroischemic foot. Deformities should be recognized early and accommodated in extra depth shoes with a high toe box and a soft insole, before any ulceration occurs. Common deformities seen in diabetics are discussed below.
