Causative factors

Contributory factors

– Peripheral neuropathy: present in 50% of patients with diabetes aged >60 years; increases risk of foot ulceration 7-fold

– Excessive plantar pressure: related to limited joint mobility and foot deformities

– Repetitive trauma

– Atherosclerotic peripheral vascular disease affecting femoropopliteal and smaller vessels below the knee

– Several intrinsic wound-healing disturbances: impaired collagen cross-linking and metalloproteinase function, immunologic perturbances, higher rates of onychomycosis and toe-web tinea infections

– Obesity and poor vision leading to impaired self-care