A 36-year-old woman with type 1 diabetes presented with a 4-week history of a dry, black great toe and third toe on the right foot (Figure 213-1). She said that she noticed severe maceration between the first and second interspace approximately 6 weeks ago. Subsequently, the toes changed color and became very painful. Two days ago, she noticed a foul odor from both toes. The patient reported smoking since she was 13 years old. On physical examination, there were no palpable pulses in the right foot. The patient was admitted for IV antibiotics and revascularization was performed. Subsequently, the toes were partially amputated and the wounds healed without any complications. Her physicians attempted to help her to quit smoking without success.