Spontaneous auto-amputation of the foot in a case of diabetes, atherosclerosis and gangrene.

Auto-amputation is the spontaneous separation of non-viable tissue from viable tissue, and is usually associated with dry gangrene, occurring in the distal portions of the lower extremities. A 68-year-old female presented with dry gangrene of both feet and subsequent loss of the right foot and digits on the left foot over a period of one and half years. After about six months disarticulation of the right foot from the ankle joint resulted. She gradually lost the digits of the left foot two months later. She had pallor and showed absence of popliteal and distal pulses on both sides. The left foot showed absence of the digits with exposed 3rd and 4th metatarsals and some areas of gangrene and sloughing. Her Hb was 5.4 g/dl and random blood sugar was 340 mg%. Doppler study of the lower limbs showed blockage at the level of the superficial femoral artery on the right side and a patent popliteal artery on the left. She was managed conservatively as she was unwilling for surgical intervention.