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.
82 year old male, heavy smoker, developed right heel ulcer during rehab after a femur fracture.
62 year old female with 2 months of short distance claudication and rest pain at night
46 year old male, type 1 diabetes, with ulcers on several toes. Patient had palpable pulses at the ankle.