67 year old male, ype1 diabetic, with painful ulceration at the tip of the second toe. Patient did not toe amputation. Although toe amputation sounds simple it leads to biomechanical changes in the foot which can cause progressive deterioration and further more significant amputations. Angiography showed the severe stenosis in the plantar arch. The plantar arch was incomplete with no connection between the medial and lateral plantar arteries. This predisposes the toes to ischemia. Additionally, the dorsalis pedis artery was occluded in the distal foot. Simple angioplasty of the pedal arch via the lateral plantar artery resulted in healing of the toe ulcer.
Unusual cause of extremity pain in a diabetic patients
Endovascular therapy of external iliac and common femoral artery occlusion with 31 month follow up
Recurrent lower extermity DVT should prompt an investigation for venous outflow obstruction. Too often these patients are under treated.