A 58-year-old woman with uncontrolled type 2 diabetes, hypercholesterolemia, and tobacco use presented with a 2-month history of a nonhealing ulceration on her left foot (Figure 210-1). She believes this started after she stepped on a tack. She presented with the ulcer, loss of protective sensation, and a nonpalpable posterior tibial pulse. She began treatment in a wound care center. Arterial noninvasive studies showed severe vascular disease and she underwent revascularization. While in the hospital, she quit smoking and gained control of her diabetes. Her ulcer healed and she continues to take her diabetes medications and does not smoke.