49 yo man with ulcer in his left heel for a month. It began | Figure 1

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49 yo man with ulcer in his left heel for a month. It began with pain and blister, then it erupted and became ulcers. He has no history of diabetes, but had been a heavy smoker (around 40 cigarettes a day) for 30 years. There is no coldness in his foot, no claudication, good pulse. Non fasting Blood glucose 198. I treated this as Buerger's disease; I gave him antibiotics, painkiller, debridement, and gave him cilostazol, hoping to improve the blood flow. The patient then stopped smoking, and after 2 days of smoking cessation, the pain increased, so I gave him codeine to relieve his symptoms. I don’t have a Doppler. Any suggestion?

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