Answer 1 is incorrect. 16% chose this answer, “Refer to a podiatrist for debridement of the callus and initiate custom orthotics.” While podiatry referral is important, vascular compromise must be evaluated first. Debridement in a patient with peripheral arterial disease (PAD) could lead to poor healing or ulceration.

Answer 2 is incorrect. 1% of you chose this answer, “Reassure JT that this is only a minor issue since they are not experiencing pain and schedule follow-up in 6 months.” Absence of pain does not exclude serious pathology, especially in individuals with neuropathy.

Answer 3 is incorrect. About 3% of respondents chose this, “Prescribe a topical antifungal for the toenails and instruct JT to inspect feet weekly and apply moisturizing cream.” This addresses a minor issue (onychomycosis), but ignores signs of ischemia and neuropathy.

Finally, Answer 4 is correct. 77% chose this answer, “Recommend vascular imaging and refer to a vascular specialist due to abnormal ABI and diminished pulses.”  ABI values <0.9 indicate PAD; values <0.5 are considered severe. Given the ABI of 0.6 and 0.7, along with diminished pulses and gait change, vascular referral is necessary to assess perfusion and prevent future ulceration or amputation.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!