A neurogenic ulcer begins with thickening and a callus on an area of pressure, as seen on the left on this foot, followed by skin breakdown (an ulcer), as seen on the right. The toes can also be affected by neurogenic ulceration; the dark color is due to bleeding into the area of pressure and callus. This neurogenic ulcer has occurred on a common pressure area, the ball of the foot near the great toe.
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Diabetic Ulcer (Neurogenic Ulcer)  Information for adults

Picture of Diabetic Ulcer (Neurogenic Ulcer): A neurogenic ulcer begins with thickening and a callus on an area of pressure, as seen on the left on this foot, followed by skin breakdown (an ulcer), as seen on the right. Divider line
A neurogenic ulcer begins with thickening and a callus on an area of pressure, as seen on the left on this foot, followed by skin breakdown (an ulcer), as seen on the right.
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Self-Care Guidelines
The key is to prevent ulcers from forming:
  • Inspect feet daily, including the areas between the toes, to look for any breaks in the skin; blisters; or red, irritated areas. A mirror can help you see the bottoms of your feet, or have a family member or caretaker do this.
  • Trim toenails regularly.
  • Make sure to wear well-fitting, cushioned shoes and pressure-reducing hosiery – indoors and outdoors – to reduce risk of injury. If you wear socks, make sure that any folds in the socks are smoothed out before putting shoes on. Avoid wearing flip-flops and wearing shoes without socks.
  • Do not go barefoot: there is significantly more pressure on bare feet than feet in proper-fitting, cushioned shoes.
  • Do not use medicated pads to treat corns, calluses, or warts on the feet, as these pads can cause ulcers; instead, speak to a professional about removal.
  • Test bath water with your fingers instead of stepping in it; if your feet lack sensation, they may get burned by water that is too hot.
It is important to note that if you have had an ulcer previously, it is very common to get more. You should follow the tips above and consider decreasing pressure on your feet by trying to walk less (try non-weight bearing exercise, such as swimming, cycling, or rowing), getting cushioned shoes (your insurance may pay for them), and considering changing to a job that does not require much walking or standing.

Additionally, smoking can worsen blood flow, further slowing down healing. It is very important to make sure that you keep your blood sugar under tight control, as elevated blood glucose actually reduces the body's ability to fight infection and slows down wound healing.
When to Seek Medical Care
People can develop peripheral neuropathy without even being aware of it, so it is important for diabetics to be examined by their doctor every 6 months. The doctor will use a special test, called a monofilament test, to assess the sensation on the bottoms of your feet.

All ulcers should receive treatment. Also see your health care provider if you feel a lack of sensation in your feet, there is any discoloration, pain, swelling, redness, oozing, or fever.

Neurogenic ulcers can lead to amputation if care is delayed, so it is important to be seen by your physician as soon as possible.
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Last Modified: 22 Dec 2008
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