Peripheral arterial disease and ulcers Quiz: Ace Your Exams

A 75-year-old man was referred to the vascular clinic for a four-month history of atraumatic leg pain and an ulcer. The patient has bilateral calf pain when doing tasks around the house. The pain is typically relieved after resting for a few minutes. An ulcer on the top of the left foot appeared 3 weeks ago. There is no associated chest pain, shortness of breath, unintentional weight loss, or fatigue. The patient’s past medical history is significant for type 2 diabetes mellitus, hyperlipidemia, and hypertension. Current medications include metformin, semaglutide, atorvastatin and hydrochlorothiazide. Temperature is 37.0 °C (98.7 °F), pulse is 85/min, and blood pressure is 122/83 mmHg. Physical examination of the lower extremities reveals cool legs with little to no hair, delayed capillary refill in the toes, and diminished pulses bilaterally. There is a 1 cm ulcer with a dry base on top of the left forefoot. There is no edema in either extremity. Which of the following additional findings is most likely to be seen in this patient?