The most common etiology of plantar ulcers in diabetic patients is neuropathy. In individuals with diabetes, peripheral neuropathy can lead to a loss of sensation in the feet. This loss of sensation means that patients may not notice small injuries, blisters, or pressure sores that develop on the feet. Over time, these unnoticed injuries can worsen, leading to the formation of ulcers.
Neuropathy often results in abnormal foot mechanics, as the loss of sensory feedback affects a person's gait and how weight is distributed across the foot. This improper weight distribution can create areas of increased pressure, which contribute to the formation of ulcers, particularly on the plantar surface.
While poor circulation and infection can certainly play a role in the development and exacerbation of ulcers in diabetic patients, neuropathy is the primary factor that initially leads to the formation of plantar ulcers by allowing injuries to go unrecognized. Dermatitis, although it can occur in diabetics, is not typically the main cause of plantar ulcers, making neuropathy the most significant underlying issue in this context.