Problem: Mrs. Smith, 67 years-old, comes to the foot clinic and reports a large circular callous that has developed on the heel of her left foot. She has increased pain with walking on her heel and occasionally notices a foul smelling drainage and wet appearance of the ulcer. On clinical evaluation of the feet, she is noted to have decreased pulses, sparse pedal hair and a loss of sensation. The nurse practitioner understands that the underlying pathophysiology of the ulcer: Group of answer choices is due to unrelieved compression and pressure of a bony prominence. involves peripheral neuropathy can result in abnormal pressures of the foot, leading to hyperkeratosis of the tissue. that lack of arterial flow and tissue perfusion creates an environment for callous formation.