A 60-year-old man with poorly controlled diabetes presents with a chronic non-healing plantar foot ulcer beneath the second metatarsal head. He has peripheral neuropathy and absent ankle reflexes. Angiography shows significant peripheral arterial disease with an ankle-brachial index of 0.5. The most important initial management step for this wound is:

• A Total contact casting
• B Vascular surgery consultation for revascularization ✓
• C Intravenous antibiotics
• D Surgical debridement under anesthesia

Explanation

An ankle-brachial index of 0.5 indicates critical limb ischemia (normal >0.9, ischemic <0.4-0.5). In diabetic foot ulcers with significant peripheral arterial disease, wound healing is impossible without adequate blood supply. Vascular surgery consultation for revascularization must precede other wound care measures. Total contact casting and debridement are appropriate only after perfusion is restored. Antibiotics alone will not heal an ischemic wound.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.