Gangrene and Necrosis

Mr. Raymond Cole, 67, a type 2 diabetic and 40 pack-year smoker. Presents with a 2-week history of worsening pain and discolouration of his right great toe, which he initially attributed to a blister from new shoes. On examination the toe is black, dry, and shrunken with a clear line of demarcation at the base. His right foot is cool with absent dorsalis pedis and posterior tibial pulses. He is a non-healing wound on the plantar surface of his second toe. His ABPI is 0.45.