Diabetic Foot Ulcer Diagnosis and Management

Location and Etiology

Diabetic foot ulcers due to neuropathy occur on plantar surfaces of the forefoot, midfoot, or areas of high pressure from deformities, according to the American Diabetes Association 1, 2
Atherosclerotic (ischemic) ulcers in diabetics typically present on the toes, heel, or lateral foot over bony prominences, not the medial leg, as stated by the American Heart Association 1
The medial leg location essentially rules out typical diabetic neuropathic ulceration, which requires repetitive mechanical stress on an insensate plantar surface, as noted by the American Diabetes Association 2, 3

Palpate pedal pulses and measure ankle-brachial index to assess for coexisting arterial disease, as recommended by the American College of Cardiology 1, 4
An ABI <0.9 indicates peripheral arterial disease, though it may be falsely elevated in diabetics due to arterial calcification, according to the American College of Cardiology 1, 4
Consider toe pressures or transcutaneous oxygen pressure (TcPO2) for more accurate vascular assessment in diabetics, as suggested by the American Diabetes Association 1, 4