A 70-year-old woman with Type 2 Diabetes Mellitus receiving chronic hemodialysis presented with a diabetic foot neuropathic plantar ulcer. Because diabetic neuropathy reduces protective sensation, repetitive pressure during walking can damage the skin without causing pain, leading to chronic ulceration despite preserved blood flow.

Surgical debridement removed all devitalized tissue until a healthy wound bed was achieved. Treatment was combined with customized off-loading using a therapeutic shoe to eliminate pressure on the ulcer and promote uninterrupted healing.

The ulcer healed completely with restoration of intact skin. Effective off-loading, combined with meticulous surgical debridement, prevented continued mechanical stress and achieved durable wound closure despite the patient’s impaired healing capacity associated with chronic hemodialysis.

This case demonstrates that successful treatment of neuropathic plantar ulcers depends not only on surgical debridement but also on strict pressure off-loading, which is essential for durable healing and prevention of recurrence.