Atheroembolic Blue Toe Syndrome Progressing to Below-Knee Amputation Despite Attempted Source Control and Revascularization: A Case Report
5 affiliations
- 1College of Arts and Sciences, Florida State University, Tallahassee, USA
- 2Department of Urology, National Medical Association and Research Group, Gainesville, USA
- 3Department of Nursing, Florida State University, Tallahassee, USA
- 4Shepard Broad College of Law, Nova Southeastern University, Davie, USA
- 5Department of Podiatry, Miami Foot Center, Miami, USA
Abstract
Blue toe syndrome is characterized by painful blue or violaceous discoloration of one or more toes caused by impaired digital arterial perfusion. We present a 72-year-old woman with peripheral arterial disease, diabetes mellitus, antiphospholipid syndrome, and prior thromboembolic disease who developed dusky-blue discoloration of the left third toe. Initial arterial duplex demonstrated no major arterial occlusion, while computed tomography angiography with runoff showed distal infrarenal aortic soft plaque and distal tibial/pedal arterial disease. The aortic lesion was considered the suspected proximal embolic source in the setting of concomitant distal tibial and pedal arterial disease. The patient underwent endovascular aortic repair for proximal source control, but the left third toe nevertheless progressed to dry gangrene and required amputation. Over the following months, she developed nonhealing wounds, infections with Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), worsened distal perfusion, and osteomyelitis. There were multiple limb salvage procedures, including angioplasty, toe amputation, common plantar embolectomy, plantar bypass, transmetatarsal amputation, Achilles tendon lengthening, antibiotic bead placement, and external fixation. Following these procedures, however, the foot developed worsening ischemic and infected tissue loss and needed an emergency left below-knee amputation. Final pathology demonstrated significant findings, including gangrenous necrosis, chronic osteomyelitis, calcific atherosclerosis, and tibial vessel occlusions. This case showcases how blue toe syndrome can progress despite source control when severe distal runoff disease, poor wound oxygenation, and recurrent infections are present.
Related
- Early Versus Delayed Endovascular Revascularization: Implications for Limb Salvage and Survival After Transmetatarsal Amputation
- PO154 | CORONARY REVASCULARIZATION IN ACUTE CORONARY SYNDROME IN PATIENT WITH MILD HEMOPHILIA B: A CASE REPORT
- Rapidly Progressing Interstitial Fibrosis and Glomerulonephritis due to Granulomatosis With Polyangiitis Presenting With Calf Pain
- Immune checkpoint inhibitors (ICIs) for second-line retreatment in esophageal cancer progressing after first-line immunotherapy: a single-center retrospective cohort study
- Bi-allelic intermediate ATXN2 repeat expansions are associated with slow progressing, leg-onset familial ALS
BibTeX
@article{echavarria2026atheroembolic,
title = {{Atheroembolic Blue Toe Syndrome Progressing to Below-Knee Amputation Despite Attempted Source Control and Revascularization: A Case Report}},
author = {David D Echavarria and Itamar Gal and Santiago T Espinoza and Aiden Gershbein and Daryl Gershbein},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117402},
url = {https://europepmc.org/article/PMC/PMC13727017},
note = {CC BY},
}
RIS
TY - JOUR
TI - Atheroembolic Blue Toe Syndrome Progressing to Below-Knee Amputation Despite Attempted Source Control and Revascularization: A Case Report
AU - David D Echavarria
AU - Itamar Gal
AU - Santiago T Espinoza
AU - Aiden Gershbein
AU - Daryl Gershbein
PY - 2026
DA - 2026/10/03
JO - Cureus
DO - 10.7759/cureus.117402
UR - https://europepmc.org/article/PMC/PMC13727017
AB - Blue toe syndrome is characterized by painful blue or violaceous discoloration of one or more toes caused by impaired digital arterial perfusion. We present a 72-year-old woman with peripheral arterial disease, diabetes mellitus, antiphospholipid syndrome, and prior thromboembolic disease who developed dusky-blue discoloration of the left third toe. Initial arterial duplex demonstrated no major arterial occlusion, while computed tomography angiography with runoff showed distal infrarenal aortic soft plaque and distal tibial/pedal arterial disease. The aortic lesion was considered the suspected proximal embolic source in the setting of concomitant distal tibial and pedal arterial disease. The patient underwent endovascular aortic repair for proximal source control, but the left third toe nevertheless progressed to dry gangrene and required amputation. Over the following months, she developed nonhealing wounds, infections with Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA), worsened distal perfusion, and osteomyelitis. There were multiple limb salvage procedures, including angioplasty, toe amputation, common plantar embolectomy, plantar bypass, transmetatarsal amputation, Achilles tendon lengthening, antibiotic bead placement, and external fixation. Following these procedures, however, the foot developed worsening ischemic and infected tissue loss and needed an emergency left below-knee amputation. Final pathology demonstrated significant findings, including gangrenous necrosis, chronic osteomyelitis, calcific atherosclerosis, and tibial vessel occlusions. This case showcases how blue toe syndrome can progress despite source control when severe distal runoff disease, poor wound oxygenation, and recurrent infections are present.
SN - 2168-8184
ER -