▁has ▁a ▁dram atic ▁effect ▁on ▁the ▁peri pher al ▁sens ory ▁system , ▁since ▁it ▁leads ▁to ▁loss ▁of ▁protect ive ▁sens ation ▁under ▁the ▁sole ▁of ▁the ▁foot . ▁This ▁ex poses ▁the ▁di ab etic ▁foot ▁to ▁thermal ▁or ▁mechanical ▁tra uma , ▁and ▁to ▁the ▁late ▁detection ▁of ▁in fection ▁processes ▁or ▁t issue ▁break down ; ▁ ▁effects ▁on ▁foot ▁morph ology ▁( de form ities ): ▁due ▁to ▁most ▁of ▁the ▁above ▁alter ations , ▁a ▁significant ▁im bal ance ▁of ▁peri pher al ▁mus cul ature ▁and ▁soft ▁t issue ▁occur ▁in ▁the ▁foot ▁which ▁seriously ▁al ters ▁its ▁morph ology ▁and ▁determ ines ▁the ▁on set ▁of ▁foot ▁de form ities . ▁Most ▁common ▁de form ities ▁of ▁the ▁di ab etic ▁foot ▁are ▁represented ▁by ▁a ▁high ▁longitud inal ▁arch ▁( rig id ▁cav us ▁foot ), ▁ham mer ▁to es ▁and ▁hall ux ▁val g us . ▁A ▁completely ▁different ▁morph olog ic ▁deg ener ation ▁is ▁represented ▁by ▁ne urop ath ic ▁ar th rop ath y , ▁whose ▁analysis ▁is ▁not ▁part ▁of ▁this ▁discussion . ▁ ▁Di agn osis ▁ ▁Ass ess ment ▁of ▁di ab etic ▁foot ▁ul cer ▁includes ▁ident ifying ▁risk ▁factors ▁such ▁as ▁di ab etic ▁peri pher al ▁ne urop ath y , ▁not ing ▁that ▁ 5 0 ▁percent ▁of ▁people ▁are ▁asympt om atic , ▁and ▁r uling ▁out ▁other ▁causes ▁of ▁peri pher al ▁ne urop ath y ▁such ▁as ▁alco hol