Diabetic Foot Ulcers Location
No, diabetic foot ulcers are NOT more common on the dorsal aspect of the foot—they predominantly occur on the plantar (bottom) surface and toes, with over 75% located in the toe and forefoot areas.
Primary Ulcer Locations
The evidence consistently demonstrates that diabetic foot ulcers have a characteristic distribution pattern that favors weight-bearing and high-pressure areas:
Plantar surface is the predominant location, with ulcers typically presenting on the bottom of the foot rather than the dorsal (top) aspect 1, 2.
More than 75% of all diabetic foot ulcers are located in the toe and forefoot area, making these the highest-risk zones 3.
Specific high-frequency sites include:
Location Varies by Ulcer Etiology
The anatomical distribution differs significantly based on the underlying pathophysiology:
Neuropathic ulcers concentrate on plantar surfaces of toes and metatarsal heads due to high plantar pressures and repetitive trauma in areas with sensory loss 3.
Ischemic ulcers predominantly affect toe tips (63.6%), reflecting compromised arterial perfusion to distal tissues 3.
Neuroischemic ulcers show mixed distribution across both plantar surfaces and toe tips (51.8%), combining pressure-related and perfusion-related mechanisms 3.
Clinical Implications
The plantar predominance has important preventive and surgical implications:
Most drainage procedures require plantar incisions since ulcers occur on the plantar surface 2.
The concentration of ulcers in weight-bearing areas should redirect preventive strategies toward pressure relief and protective footwear for plantar and forefoot regions 3.
Dorsal ulcers, while possible, are uncommon and should prompt investigation for atypical causes or trauma mechanisms.