Alhaji Yusuf's wife found the wound — he had felt nothing for 3 weeks. Eight years of untreated diabetic neuropathy had removed sensation from his feet. Mascot Healthcare treated the ulcer and gave him the foot care education that could prevent amputation.
Retired teacher, Mushin. Type 2 diabetic on metformin for 8 years. Presented with a 2 cm painless ulcer on the plantar surface of the right first metatarsal head — present for 3 weeks, noted when wife saw it. Surrounding callus. Peripheral neuropathy confirmed. No critical ischaemia.
Diabetic Foot Ulcer (Neuropathic)Alhaji Yusuf's wife had been asking him about his feet for months. He told her his feet were fine. They were painless — and to him, painless meant fine. On a Sunday evening, she noticed a dark stain on his sock. She examined his foot. A significant ulcer had been there for at least 3 weeks, seeping through his sock, entirely without his knowledge.
They came to Mascot Healthcare on Monday morning. The doctor examined the foot carefully: 2 cm ulcer on the plantar surface, grade 1 (Wagner classification), no bone probing positive. The ankle brachial pressure index (ABPI) was normal — no critical ischaemia. But monofilament testing showed complete absence of protective sensation in both feet.
The HbA1c came back: 9.8% — significantly above the < 7% target. "The neuropathy that allowed this wound to exist for three weeks painlessly was caused by 8 years of poorly controlled blood sugar," the doctor explained.
Diabetic foot ulcers develop from the combination of peripheral neuropathy (which removes protective pain sensation) and pressure on vulnerable foot areas. Because there is no pain, wounds go unnoticed for days or weeks.
A 2 cm ulcer on the sole of the right foot, beneath the first metatarsal head — noticed by his wife, not by Alhaji Yusuf.
Thick callus surrounding the ulcer — the foot's attempt to protect a pressure-exposed area.
Monofilament testing: absent protective sensation bilaterally — significant peripheral neuropathy.
Poorly controlled diabetes — a major driver of neuropathy and impaired wound healing.
No signs of spreading infection at presentation — allowing outpatient management.
No foot examination or self-monitoring — had not been taught to inspect his feet.
Continued wearing the same shoes — had not been told diabetic footwear requirements.
Metformin alone — HbA1c at 9.8% indicates inadequate glycaemic control on metformin alone.
Wound treatment: sharp debridement of callus and necrotic tissue; daily saline wound irrigation; non-adherent dressing; total contact cast to offload pressure from the metatarsal head. Swab taken — grew Staphylococcus aureus; a course of medication was prescribed.
Glycaemic control: his existing diabetes medication was continued and a second diabetes medication was added (well supported by evidence for diabetic foot and heart protection). Diabetology referral for review of his diabetes treatment.
Foot education: daily foot inspection with a mirror; appropriate diabetic footwear; no walking barefoot; nail care instructions; when to come immediately (any new redness, swelling, warmth, or wound).
Diabetic Foot Ulcer — neuropathic, plantar, Wagner Grade 1 (Staph aureus wound swab; HbA1c 9.8%; absent protective sensation bilaterally; normal ABPI)
Sharp debridement; total contact cast; a course of medication; daily dressing; diabetes medication optimised; diabetology referral; foot care education; diabetic footwear prescription
At 3 weeks: ulcer reduced from 2 cm to 0.8 cm. At 6 weeks: fully healed. HbA1c at 3 months: 7.6% (improving).
Ulcer healed fully at 6 weeks. No bone involvement, no amputation. HbA1c improving with medication change. Alhaji Yusuf and his wife now inspect his feet together every evening.
Diabetic peripheral neuropathy removes the pain that normally alerts us to foot injury. Daily foot inspection — not sensation — is the only reliable way to detect wounds early in diabetic patients.
Every diabetic patient should be taught the ABCD of foot care at every diabetes review — and their feet should be examined by their doctor at every annual review.
A diabetic foot wound that doesn't hurt is not a small problem. Painless means the nerve is damaged — the wound is still dangerous.
Walk in to Mascot Healthcare, Akoka — same-day consultation, transparent pricing, 4.9★ rated.