An 88-year-old man with diabetes and CKD3 has painful nocturnal leg cramps and rest pain in his left foot. The foot is cool with a small toe ulcer;

Question

An 88-year-old man with diabetes and CKD3 has painful nocturnal leg cramps and rest pain in his left foot. The foot is cool with a small toe ulcer; ABPI is 0.42 and pulses are absent. He has mild dementia but can describe his symptoms and goals. What is the most appropriate management?

Accepted Answer

Urgent vascular referral for chronic limb-threatening ischaemia assessment

Answer

Treat with topical antibiotic cream and routine podiatry

Answer

Advise walking through rest pain as exercise therapy

Answer

Apply compression bandaging

Answer

Arrange amputation without vascular imaging or shared decision-making

Chronic limb-threatening ischaemia with toe ulcer — SCE Geriatric Medicine MCQ

An 88-year-old man with diabetes and CKD3 has painful nocturnal leg cramps and rest pain in his left foot. The foot is cool with a small toe ulcer; ABPI is 0.42 and pulses are absent. He has mild dementia but can describe his symptoms and goals. What is the most appropriate management?