A 40-year-old man presented to the accident and emergency department with these black, but not especially painful, toes on his left foot. He was a known diabetic, on insulin but confessed to being very bad about taking it and was rather confused about his correct dosage.
There was diminution of sensation to both vibration and fine touch (10 g nylon monofilament) over both feet. He smoked cigarettes about 20 a day.
What’s the diagnosis ?
