A 65 year-old lady notices that the toes of her left foot appear to be turning black. She has also noticed that when she touches her feet, the skin seems quite cool to the touch, and that she has some numbness in both feet. She has had diabetes for a number of years.
There is dark brownish to blackish discoloration of the toes of the left foot. The toes still appear structurally intact, and there is no evidence of ulceration, oozing of fluid or purulent discharge.