The epidemiology of neuropathic foot ulcers in individuals with diabetes.

There is now substantial evidence that diabetic neuropathy is a major etiologic factor for diabetic foot ulcers. Epidemiologic data show a very strong association between foot ulcers and indicators of sensorimotor neuropathy. Additionally, a causal pathway (sensorimotor neuropathy, which leads to increased pressures at foot surfaces, which then leads to foot ulcers) has been postulated. Evidence suggests that other factors also contribute to foot ulcer risk through an interaction with neuropathy such as foot deformity, footwear, and body weight. There has been an effort to optimize modalities for screening diabetic patients for hypoesthesia in order to prevent foot ulcers; however, there have not been definitive prospective studies that have compared the effectiveness of available tests.