Are there two types of diabetic foot ulcers?

Neurological function was determined in diabetic patients with peripheral vascular disease and foot ulcers (n = 13). This was compared to that of diabetic patients without foot ulcers with (n = 23) and without (n = 13) symptoms of neuropathy. Diabetic patients with typical neuropathic ulcers (n = 13) and age-matched healthy controls (n = 20) were also studied. The beat-to-beat variation with deep breathing was 6.1 +/- 1.0 beats/min in those with peripheral vascular disease and foot ulcers, less than 50% of that of diabetic patients without foot ulcers (p < 0.01) or normal controls (p < 0.005). Autonomic surface potentials in the soles were greatly diminished or absent in nearly all the patients with peripheral vascular disease and ulcers. Quantitative sensory testing revealed profound abnormalities in small fiber (heat and cold sensation) and large fiber (vibration sensation) function in diabetic patients with peripheral vascular disease and foot ulcers. Our results document the presence of advanced autonomic and somatosensory neuropathy in nearly all diabetic patients with peripheral vascular disease and foot ulcers.