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Diabetic Neuropathic Ulcer — RACP Adult Medicine MCQ

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EasyEndocrinologyDiabetic Neuropathic UlcerRACP Adult Medicine

A 60-year-old man with diabetes presents with a deep painless ulcer over the first metatarsal head. Peripheral pulses are present. Monofilament testing is absent at multiple sites. Vibration sense is reduced at the ankles. What is the most likely type of ulcer?

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Correct answer: E — Neuropathic ulcer

A painless ulcer over a pressure point (metatarsal head) with intact pulses but absent protective sensation (monofilament and vibration loss) is a neuropathic ulcer. The hallmark is loss of protective sensation allowing repetitive trauma. Management includes offloading, debridement, infection control, and glycaemic optimisation.

Reference: ADS – 2024 – Diabetic Foot; IWGDF 2023 Guidelines