Heel ulcers in patients with long-standing diabetes who wear antiembolism stockings

Four patients with longstanding insulin-dependent diabetes mellitus developed heel ulceration while wearing correctly fitted antiembolism stockings after major surgery. These patients all had evidence of peripheral vascular disease and peripheral neuropathy. Heel ulceration appears to be a significant side-effect of this form of prophylaxis against venous thromboembolism in patients with long-standing diabetes mellitus. The use of antiembolism stockings in such patients, who are likely to have vascular and neurological impairment, should be undertaken with great care, if at all.