Sole hemorrhage without pain is termed?

• A. Ulcer
• B. Sequestrum
• C. Granulation
• D. Pre-ulcer

Answer: (D)

A painless hemorrhage under the sole, especially beneath a callus, is called a pre-ulcer. This represents an early, pressure-related injury in a neuropathic or at-risk foot where the skin hasn’t yet broken, so there’s no pain. The lack of pain is due to neuropathy, which blunts sensation even as blood collects under the callus. This stage flags a high risk of progression to a true ulcer if pressure isn’t relieved.

This isn’t an ulcer because the skin remains intact; it isn’t a sequestrum, which is a dead piece of bone, nor a granulation tissue finding, which refers to new tissue forming during healing. Management focuses on offloading the area, removing or reducing the surrounding callus to relieve pressure, and protecting the site with proper footwear or orthotics, along with regular foot checks to prevent progression.