What causes diabetic foot ulcers and result in infections or amputations, starts with diabetes in general. Diabetes leads to a whole cascade of problems that lead to damage in the feet. One of them is nerve supply and sensation. One can develop loss of protective sensation and quite literally wear a hole in the foot just like we'd wear a hole in a soccer issue. That's called peripheral neuropathy or loss of protective sensation. Another thing that goes out to the periphery is blood flow, so we can have a problem with peripheral artery disease. What happens there (just like in the heart, except longer) we can develop complications that limit blood flow which can not only cause wounds, but more importantly cause wounds not to heal once they show up. Both of those things - both the sensation and the peripheral artery disease - are things that we have to focus on both as patients and as doctors and nurses.