A 62-year-old woman with ...

A 62-year-old woman with a 15-year history of Type 2 Diabetes Mellitus, presents with a painful, non-healing ulcer on the plantar aspect of her right foot. Despite good glycemic control with oral hypoglycemics, the ulcer has worsened over the past three months. Numbness in her feet and occasional tingling. On examination, the ulcer measures 4x3 cm, with a necrotic base and surrounding erythema. There is decreased sensation in the foot, and a Doppler study shows reduced blood flow to the affected area.