Ulcer to the toes, what is the cause?

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This is a patient who came in with calluses to the tips of his right 2nd and 3rd toes.  The calluses had blood dried underneath.  What do you think caused this?

 

When evaluating the shoe I noted that the sock liner had moved backward and it was pinching the toes when patient was walking.  He has large feet, already a 14 but the toes were pinched and he has a job where he stands at a machine all day long.  I recommended new shoes and diabetic insoles for the patient with custom inserts.