A 60-year-old diabetic presents with a painless plantar ulcer under the first metatarsal head (grade 2 by Wagner classification) with no osteomyelitis. The mechanism of ulceration in diabetic neuropathic foot is primarily:
- A Large vessel peripheral arterial disease (PAD) causing ischemia
- B Loss of protective sensation with repetitive trauma and abnormal pressure distribution ✓
- C Immunosuppression reducing local wound healing
- D Venous hypertension causing lipodermatosclerosis
Explanation
Neuropathic ulcers in diabetes result from loss of protective sensation (somatic neuropathy) compounded by autonomic neuropathy (dry skin, Charcot tendency) and motor neuropathy (intrinsic muscle wasting leading to claw toes and abnormal plantar pressure points). The plantar first MTP region is a classic pressure point. Without pain feedback, repetitive microtrauma causes skin breakdown. Ischemic ulcers (A) are typically at the tip of toes/heels and are associated with absent pedal pulses, rest pain, and pallor on elevation. Wagner Grade 2 is a deep ulcer penetrating to tendon or capsule without bone.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.