61 year old male, diabetic, developed a lateral right foot ulcer after a pedicure. The posterior tibial artery pulse was palpable. No dorsalis pedis artery pulse. Monofilament testing showed decreased sensation typical of diabetic neuropathy. Angiography showed distal PTA stenosis and severe stenosis in the proximal lateral plantar artery - the blood supply to the wound. Interestingly, the anterior tibial artery had variant anatomy where it terminates into medial and lateral tarsal branches with no true dorsalis pedis artery. This variant has been noted to predispose the foot to ischemia.
101 year old female, admitted to the hospital with foot and toe pain. Patient had a cool pulseless foot.
67 year old male, type1 diabetic, with painful ulceration at the tip of the second toe. Patient did not toe amputation.
The tip of a hydrophilic wire was fractured and subsequently retrieved during the crossing of a distal anterior tibial artery near occlusion