15th July 2024

A 72-year-old man with a history of type II diabetes presents with pain in both feet and calves when walking

A 72-year-old man with a history of type II diabetes presents with pain in both feet and calves when walking.  Over the past few months, he’s been struggling to do his own shopping and meet his friends in the pub.  More recently, the pain has also been there at rest, in addition to long-standing pins and needles in his toes.  He is a smoker with a 30-pack year history and takes as required sildenafil for erectile dysfunction.

On examination, his dorsalis pedis and posterior tibial pulses were faint.  His feet appeared hairless, shiny and were cool to the touch.  He had an ulcer with a ‘punched out’ appearance on his left great toe with evidence of surrounding cellulitis.  Blood pressure was 160/86 and pulse 85.  Investigations were as follows:

Which of the following is the most likely cause of his calf pain?

Select the SINGLE most appropriate option from the list below. Select ONE option only.