Foot ulcers are one of the most common precursors to diabetes related amputations.8,25 Other factors that have been associated with amputation, such as infection, faulty wound healing, and ischemia, usually do not cause tissue loss or amputation in the absence of a wound. Therefore, ulcer prevention is one of the foci of any amputation prevention program. Three primary pathways or mechanisms of injury have recently been identified in the development of foot ulcers They include wounds that result from ill-fitting shoes (low-pressure injuries that are associated with prolonged or constant pressure from narrow or short shoes), repetitive moderate forces on the sole of the foot, and from puncture wounds (high-pressure injuries with a single exposure of direct pressure). The most common mechanism involves the second scenario (receptive moderate force). Except for puncture wounds, areas that are likely to ulcerate have been associated with increased local skin temperatures due to inflammation and enzymatic autolysis of tissue. Several reports have suggested that wounds develop due to a cumulative effect of unrecognized repetitive injury over the course of several days. Identifying areas of injury by the presence of inflammation would then allow patients or health care providers to take action to decrease the inflammation before a wound develops.