A recent systematic review found that one in every five patients with diabetes and peripheral neuropathy undergoing a partial first ray amputation subsequently required a more proximal amputation.

A 54-year-old woman presents with bilateral leg lesions that are pruritic and bothersome, a condition that is several years in duration. She has seen several physicians for this condition but “no one seems to be able to help” her. As she is sitting in the treatment chair, the patient actively scratches her legs and forearms. She says there is something “underneath” and she must “get it out.” She denies that the itching gets worse at night but notes that it bothers her throughout the day.