Emboli minimal neuropathy and severe localized pain

A 51-year-old woman with type 2 diabetes of 7 years' duration was referred to the diabetic foot clinic by the vascular surgeon who had diagnosed peripheral embolic disease. She had very discrete areas of non-blanching blue discolouration on the tips of her right 3rd and 5th toes (Fig. 6.8). Her pressure index was 0.5 and her vibration perception threshold was 20 volts.

Angiography had shown multiple stenoses of the right superficial femoral artery and she was due for angioplasty. Aspirin and dipyridamole had been prescribed by the

Fig. 6.5 (a) The foot has developed spreading necrosis, (b) Close-up view of foot, (c) The patient had fever whilst the necrosis was spreading and this resolved when ceftazidime as antipseudomonal treatment was started.


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