Question
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?
| A. |
Neuropathic ulcer |
| B. |
Trophic ulcer |
| C. |
Venous ulcer |
| D. |
TB ulcer |
Show Answer
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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.