Small vessel disease: a cause of foot ulceration in the neuropathic foot?

There is increasing evidence for the involvement of small vessel disease in the aetiology of diabetic foot ulceration. We describe two diabetic neuropathic patients with toe ulceration despite bounding foot pulses, normal ankle brachial pressure indices and arteriograms. In both patients, toe pulp temperatures were markedly lower than mid‐foot temperatures. The presence of digital ischaemia in the absence of macroangiopathy suggests small vessel disease which may play an important role in the aetiology of diabetic foot ulceration. Furthermore, such patients should be given appropriate advice regarding foot care and shoe‐wear in order to reduce the risk of digital ulceration.