National Health Service Trust

Diabetic Foot Discolouration

Fig. 6.6 (a) Acute ischaemia: the foot is grey, pallid and cold and needed distal bypass for limb salvage, (b) Two days after her distal bypass the foot has developed small blisters on the dorsum and the tips of the toes are discoloured, (c) Two weeks later the discoloured areas were necrotic, (d) One month after the discolouration was first noted the necrosis demarcated and stopped extending.

Necrosis Diabetic Foot

Fig. 6.6 (a) Acute ischaemia: the foot is grey, pallid and cold and needed distal bypass for limb salvage, (b) Two days after her distal bypass the foot has developed small blisters on the dorsum and the tips of the toes are discoloured, (c) Two weeks later the discoloured areas were necrotic, (d) One month after the discolouration was first noted the necrosis demarcated and stopped extending.

Embolic Shower Toes
Fig. 6.7 A shower of emboli has led to necrosis of four toes.
Fig. 6.8 Discrete areas of non-blanching blue discolouration on the tip of the right 3rd toe. This toe was so painful that she would not allow us to cut the nail.

vascular surgeons. She had neglected toenails which were cut except for the right 3rd which she could not bear to be touched because it was so painful. She underwent angioplasty with almost immediate improvement in her pain and her pressure index rose to 0.9. The blue areas developed superficial necrosis which healed over the next 3 months.

Key points

• Peripheral emboli present as areas of discrete bluish discolouration in one or more toes

• The origin of the emboli in this case was atherosclerotic plaques in the superficial femoral artery

• Such patients with peripheral embolic disease should receive antiplatelet therapy and vascular intervention if there is proximal arterial occlusive disease.

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