MCQ – 89434

A patient presents with a well-defined ulcer over the plantar aspect of the foot. The ulcer is located on a pressure-bearing area and has a punched-out appearance with a surrounding rim of callus and healthy granulation tissue at the base, as shown in the image.

What is the most likely diagnosis?

Correct Answer » A Explanation

• Ulcer is located on the plantar surface of the foot.
• It is situated over a pressure-bearing area.
• The ulcer has a punched-out appearance.
• There is a thick surrounding callus.
• The floor shows healthy granulation tissue.
• These features are characteristic of a neuropathic (diabetic) plantar ulcer.

Clinical Explanation

• Neuropathic ulcers occur due to loss of protective sensation from peripheral neuropathy.
• Repeated trauma and pressure during walking lead to ulcer formation.
• The ulcer is typically painless because of sensory loss.
• Diabetes mellitus is the most common underlying cause.

Explanation of the Correct Answer

A. Neuropathic ulcer

Features supporting this diagnosis:

• Plantar location
• Pressure-bearing area
• Thick surrounding callus
• Punched-out margins
• Healthy granulation tissue
• Usually painless
• Commonly associated with diabetic peripheral neuropathy

Why Other Options are Incorrect

B. Trophic ulcer

• Trophic ulcer is a general term for ulcers resulting from loss of nerve supply.
• A diabetic plantar ulcer is a type of trophic ulcer.
• However, the specific diagnosis for this image is neuropathic ulcer.

C. Venous ulcer

• Usually occurs around the medial malleolus.
• Has irregular, shallow margins.
• Associated with edema, varicose veins, lipodermatosclerosis, and skin pigmentation.
• Not seen on the plantar surface.

D. Tuberculous (TB) ulcer

• Rare.
• Has undermined edges and unhealthy granulation tissue.
• Usually associated with evidence of tuberculosis elsewhere.
• Does not present with surrounding callus.