78 year old female with past medical history significant for type 2 DM, hypertension and past smoking (quit 2 years ago). She noticed an area of non healing ulcer on the left first toe following an intervention for an ingrown nail by her podiatrist. She reports pain over the left first toe extending proximally along the medial side of foot. Foot x-ray and MRI ruled out osteomyelitis. Vascular studies were done. ABI on the left leg was 0.37 and right leg 0.58. Peripheral angiogram done at an outside hospital showed a total occlusion of the left anterior tibial artery. Left PT and peroneal have moderate disease.