Painful in Surgery — 58yo Man | Vascular Surgery | SMLE Q#11553
SMLE Question #11553
Surgery
Vascular Surgery
Last updated: February 2026
A 58-year-old man with poorly controlled type 2 diabetes mellitus and a 30-pack-year smoking history presents with painful, nonhealing punched-out ulcers on the tips of the left 2nd–4th toes for 3 weeks. He reports calf pain after walking a short distance that resolves with rest. Examination shows shiny, hairless skin, delayed capillary refill, and absent dorsalis pedis and posterior tibial pulses bilaterally; femoral and popliteal pulses are palpable and symmetric. What is the most appropriate next step in management?
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