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In an extremity supplied by arteriosclerotic vessels, the most distal parts will be subject to tissue changes should the peripheral circulation be in any way further impaired. In a case of arteriosclerosis, with no palpable blood vessel pulsation, and with oscillometric readings of zero, the presence of a gangrenous toe or a portion thereof does not necessarily indicate that the circulation of the extremity is such as to require amputation of any portion of the extremity except the involved local part.
Spontaneous gangrene of the toe is extremely rare if it ever occurs. Such a condition would imply that the circulation to the toe for some unexplainable reason was suddenly stopped. On the contrary, in nearly every case of gangrene of the toe some history of trauma can be elicited, even though the trauma may have been so minor as to have been practically unnoticed by the patient. All trauma
David A. Willis. EXACTING CONSERVATIVE MANAGEMENT OF THE GANGRENOUS TOE. JAMA. 1952;148(11):937. doi:10.1001/jama.1952.62930110005013b