Write a 8 pages paper on ischemic ulcer in a diabetic patient. Other important findings in the history include the presence of intermittent claudication of the left lower limb for one year. John is a chronic smoker. He decreased smoking since one year after the onset of claudication symptoms, following advice from a physician. However, he has not been able to completely quit smoking. During the current visit to the hospital, there is no history of fever or any other symptoms. The patient complains that the onset of ulcer started after he began to wear new slip-on shoes with a narrow toe box. The patient reported being allergic to penicillin. There is no history suggestive of occupational injury, trauma, varicose veins, previous history of lower limb wounds/ulcers/gangrene, history of amputations and history of any other surgeries. There is no family history of similar ulcers either. The patient is not suffering from any collagen diseases. He is not on any anti-inflammatory drugs or steroids.


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