Sensory loss with digital amputation always gives a first impression of leprosy in Asian countries, but other causes need to be fully investigated. Leprosy is a chronic disease of low infectivity and clinically manifests as a wide range of skin and nerve lesions, leading to permanent damage to the skin and nerves. Mosby’s Medical Dictionary 2009 defines trophic ulcers as “a pressure ulcer caused by external trauma to a part of the body that is in poor condition because of disease, vascular insufficiency or loss of afferent nerve fibres”. Besides leprosy, other causes of trophic ulcers should be borne in mind. A rare case of spina bifida occulta and diastematomyelia with scoliosis, an important differential diagnosis of Hansen’s disease, is presented here (Siddappa, 2013).