Neurogenic ulcers (also known as neuropathic and diabetic ulcers; mal perforans) will affect approximately 15% of individuals with diabetes during their lifetime. The pathogenesis of these ulcers is multifactorial and has to do with peripheral vascular disease, peripheral neuropathy, repetitive trauma, and mechanical change in the bony architecture of the foot over time. They occur over pressure points on the feet of individuals who have had diabetes for many years.

While the overwhelming majority of neurogenic ulcers occur in individuals with diabetes, any condition resulting in polyneuropathy (alcohol use disorder, arsenic poisoning, etc) or local neuropathy (eg, herpes zoster, Hansen disease) will predispose an individual to their formation.

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.