Mrs. Lee, who was in her eighties, remained quite mobile despite her age. Although she did not exercise much, she could still move around at home, shop for groceries, and cook without much difficulty.

Several months earlier, she noticed some pain in the second toe of her left foot. She assumed she had simply knocked it and did not think much of it, taking a few painkillers. Gradually, however, the tip of the toe turned black. She thought it was only part of the injury and applied ointment casually, but the condition did not improve. Instead, the dark discoloration spread to the entire toe, and the pain became more and more severe, even disturbing her sleep at night.

Mrs. Lee was very afraid of hospitals and seeing doctors, so she delayed seeking help and did not tell her family. Only when the pain became unbearable and she noticed that other toes were also beginning to darken did she finally decide to seek medical attention.

After several consultations, a vascular surgeon eventually diagnosed chronic arterial blockage in her left leg. Because blood could not be delivered effectively to the foot, the toe gradually died from inadequate circulation, rather like a branch of a tree withering when it no longer receives enough nourishment. In medical terms, this is called gangrene. It is a warning sign of critically reduced blood supply to the lower limb. If blood flow cannot be increased in time, the area of dead tissue may continue to enlarge and may also become infected, making amputation difficult to avoid.

Mrs. Lee and her family were understandably worried about surgery at such an advanced age. In modern vascular practice, however, many procedures can now be performed using minimally invasive techniques. Through a small wound, light anaesthesia, and specialized endovascular instruments, it may be possible to reopen a blocked artery. Even in older patients, the chance of technical success may still be good in appropriately selected cases. From a clinical point of view, this may be preferable to ongoing severe pain or untreated tissue loss.

Author: Honorary Clinical Associate Professor, Department of Surgery, The University of Hong Kong; President, Vascular Health Foundation