94 year old female, worsening right toe and foot pain. Seen by primary care and diagnosed as having gout. The clinical findings of critical limb ischemia - dry scaly skin, nail changes, absent pulses and a punched out ulcer on the 2nd toe - were ignored. Popliteal artery occlusion treated with atherectomy.
59 year old male, smoker, sudden onset of pain and discoloration of the right 3rd toe.
Current physiologic testing for ulcer perfusion may fail to identify patients with ischemia