When a diabetes foot ulcer is not always a diabetes foot ulcer: The importance of thinking outside of the box, and looking above the foot

Published Date: 01st February 2025

Publication Authors: Sullivan. H, Pendlebury. H, Cowan. M, Cairns. J, Furlong. NJ

Conference Abstract 

Introduction: A diabetes foot ulcer is defined as a localised injury to the skin/underlying tissue, below the ankle, in a person with diabetes. Foot ulcers are routinely caused by a combination of peripheral neuropathy, arterial disease, pressure, callus formation, trauma, slow wound healing and deformity. The multidisciplinary diabetes foot team accepts referrals for any patient meeting these criteria. At assessment, we review their full history, medications and examine their feet, arterial supply, sensation, the foot condition and their cardiovascular risk to determine an appropriate management plan.

Clinical Case: This case describes an 82-year-old woman with a history of diabetes, multiple basal cell carcinoma (BCC), asthma and atrial fibrillation. She presented with intact sensation and palpable, biphasic pulses but three 1.0 x 1.0 x 0.1 cm ulcerations on the lateral border of her right foot. Due to their non-classical nature, further examination was performed. Initially BCC was considered as a possible differential. However, upon identifying unilateral leg swelling and a large subcutaneous mobile mass within her right upper thigh/groin, an US scan confirmed a large, heterogeneous mass suspicious for malignancy. Further MRI and biopsy confirmed a primary Sarcoma for which she is now undergoing treatment.
Conclusion(s): This case highlights the importance to think outside the box; while any wound below the medial malleolus may be classed as a diabetes foot ulcer, this may not always be the cause. Diabetes can cause so many complications and problems, but it is imperative to not be blinded by this clinically and always keep an open mind for differential diagnoses.

Sullivan, H.; Pendlebury, H.; Cowan, M.; Cairns, J.; Furlong, N. (2025). When a diabetes foot ulcer is not always a diabetes foot ulcer: The importance of thinking outside of the box, and looking above the foot. Diabetic Medicine. 42(Supp 1). [Online]. Available at: https://dx.doi.org/10.1111/dme.15498 [Accessed 4 February 2026].