Neurogenic ulcers (also known as neuropathic and diabetic ulcers; mal perforans) are ulcerations on the pressure points of the foot caused by repetitive trauma. Neurogenic ulcers are typically found in individuals with peripheral neuropathy, diabetic peripheral neuropathy, anatomic deformities of the foot, Charcot neuroarthropathy, or peripheral artery disease. The pathogenesis is typically due to neuropathy but may be multifactorial (eg, neuropathy and peripheral artery disease). Secondary infection of the ulcer may prevent healing.

Neurogenic ulcers are most commonly seen in individuals with long-standing diabetes; it is one of the most common complications of diabetes mellitus (type 1, type 2) and affects approximately 19%-34% of individuals with diabetes during their lifetime. There is a recurrence rate of 60% in 3 years for individuals with diabetes. Twenty percent of neurogenic ulcer patients with diabetes will require amputation with a 70%, 5-year mortality after amputation. The presence of neurogenic ulcers in diabetic patients increases mortality by 2.5-fold. While the overwhelming majority of neurogenic ulcers occur in individuals with diabetes, other conditions can cause polyneuropathy (eg, alcohol use disorder, arsenic poisoning) or local neuropathy (eg, herpes zoster, Hansen disease) and can also be precipitating factors.

Neurogenic ulcers are difficult to treat, frequently recur, and result in significant morbidity in the form of loss of function and, often, loss of limb.