A 34-year-old Caucasian woman presented with complaints of years regarding pain in her feet. She said that they ache and turn purple, but no one believes her. She has had multiple surgeries for other likely causes of foot pain, including bilateral bunionectomies, but her pain continues to worsen. Aggravating factors are excessive activity and cold weather.

On examination, there were healed scars corresponding with her previous surgeries. Her feet appeared slightly dusky and were cool to the touch. Pedal pulses were faint, even with Doppler. She had poor capillary refill on her toenail beds. Her femoral and popliteal pulses, however, were strong. And MRA showed bilateral absence of the medial and lateral branches of the popliteal artery below the knee, with only the central branch visible. Unfortunately, few options were available to her for symptom relief and none surgically. Without native vessel no surgical intervention would be possible. A localized trial of nitroglycerin ointment to the dorsal aspects of both feet failed to provide pain relief. She was educated on the importance of protecting her feet from injury or infection and consulted with the pain management clinic. (216-5)

Sherril Sego, FNP-C, DNP, is an independent consultant in Kansas City, Mo.


These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.




These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.