A painless plantar lesion in a patient with diabetes on the plantar surface with neuropathic symptoms is most likely which diagnosis?

A painless plantar lesion in a patient with diabetes on the plantar surface with neuropathic symptoms is most likely which diagnosis?

• A. Plantar Wart
• B. Corn
• C. Callus
• D. Neuropathic Ulcer

Answer: (D)

Loss of protective sensation in diabetic neuropathy allows pressure and minor trauma to progress into tissue breakdown without pain. The plantar surface bears weight, so repeated pressure at that site frequently leads to a painless ulcer in this setting. A neuropathic ulcer is typically a well-defined lesion on the sole, often with surrounding callus, and is accompanied by neuropathic symptoms like numbness or tingling rather than pain. In contrast, a plantar wart arises from HPV and usually presents with a rough surface and sometimes pinpoint bleeding points, not specifically tied to neuropathy. A corn or callus is a thickened, keratinized area from ongoing friction and is usually painful under pressure, without the tissue loss and sensory deficit that define a neuropathic ulcer.

Loss of protective sensation in diabetic neuropathy allows pressure and minor trauma to progress into tissue breakdown without pain. The plantar surface bears weight, so repeated pressure at that site frequently leads to a painless ulcer in this setting. A neuropathic ulcer is typically a well-defined lesion on the sole, often with surrounding callus, and is accompanied by neuropathic symptoms like numbness or tingling rather than pain.

In contrast, a plantar wart arises from HPV and usually presents with a rough surface and sometimes pinpoint bleeding points, not specifically tied to neuropathy. A corn or callus is a thickened, keratinized area from ongoing friction and is usually painful under pressure, without the tissue loss and sensory deficit that define a neuropathic ulcer.