A 51-year-old African-American male with poorly controlled diabetes, hypertension, and a past history of smoking presented to us with right foot rest pain in early November 2009. He underwent a duplex examination, followed by right leg angiogram with SFA angioplasty. Two weeks later, he presented to his podiatrist with a new abscess in the left foot. This was drained and followed by TMA (trans-metatarsal amputation) 4 days later. In the interval, the patient followed up with us in the clinic and had noninvasive physiologic imaging, which is compared to previous imaging from 2008.