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Diabetic Foot OSCE Examination Quiz
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On close inspection of a diabetic foot, which finding is most characteristic of a neuropathic ulcer?
- A A painless ulcer over the lateral malleolus with surrounding haemosiderin staining You picked ✕
- B A painless, punched-out ulcer with surrounding callus over a metatarsal head You picked ✓
- C A painful ulcer on the heel with surrounding callus You picked ✕
- D A painful ulcer over a metatarsal head with surrounding callus You picked ✕
- E A painless ulcer at the tip of a toe on a pale, cool foot You picked ✕
Correct!
Incorrect
The answer is B: A painless, punched-out ulcer with surrounding callus over a metatarsal head
Explanation
Why B is correct
See Closer Inspection of the Feet. Option B is correct. A neuropathic ulcer develops because the nerves have been damaged by diabetes, so the foot has lost protective sensation (the ability to feel pain from pressure or injury). Repeated minor trauma, such as the pressure of walking over the metatarsal heads (the knuckles at the ball of the foot) or the heel, therefore goes unnoticed and the tissue breaks down. The ulcer is typically painless, has punched-out edges and sits over a pressure point. Callus (thickened skin) forms where pressure is abnormal and can act like a foreign body, raising the pressure on the tissue beneath and predisposing to ulceration. By contrast, an ischaemic ulcer (one caused by poor blood supply) tends to be painful and sits at the toe tips or other peripheral watershed areas where perfusion is poorest. A plain-language aid: no feeling means no pain, so the ulcer is painless and sits where the foot takes the weight.
- Cause: Diabetic nerve damage removes protective sensation.
- Appearance: Painless ulcer with punched-out edges.
- Site: Pressure points such as the metatarsal heads or heel, often with callus.
- Contrast: An ischaemic ulcer is painful and sits at the toe tips.
Why the other options are incorrect
- A. A painless ulcer over the lateral malleolus with surrounding haemosiderin staining: An ulcer over the lateral malleolus with haemosiderin staining suggests venous disease, not the pressure-point neuropathic ulcer of the diabetic foot. Your answer
- C. A painful ulcer on the heel with surrounding callus: A neuropathic ulcer is painless, so a painful heel ulcer with callus does not fit the classical neuropathic description. Your answer
- D. A painful ulcer over a metatarsal head with surrounding callus: A neuropathic ulcer is typically painless because protective sensation is lost; a painful ulcer with callus over a metatarsal head is not the expected neuropathic picture. Your answer
- E. A painless ulcer at the tip of a toe on a pale, cool foot: Painless ulcers at the toe tips on a pale, cool foot suggest ischaemic or neuroischaemic disease; the classic neuropathic ulcer occurs over a pressure point such as the metatarsal head. Your answer
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More questions from this set. Start the quiz to answer them and see each explanation.
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1
A 58-year-old woman with long-standing type 2 diabetes has a painless, punched-out ulcer under the first metatarsal head, surrounded by callus, and she has little discomfort when walking. What best explains this finding?
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2
A student has finished the bedside parts of a diabetic foot examination. Which statement best describes how to complete it?
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