Question: A 75-year-old Man Is Being Seen In The Community Clinic For An Ulcer On The Medial Malleolus Of The Right Ankle. He Describes A “heavy Burning Sensa- Tion” In The Lower Legs. He Worked For Many Years As A Toll-booth Attendant, Often In A Standing Posi- Tion. He Reports Having Had Hypertension In The Past But Takes No Medication For It Now. Physical …

A 75-year-old man is being seen in the community clinic for an ulcer on the medial malleolus of the right ankle. He describes a “heavy burning sensa- tion” in the lower legs. He worked for many years as a toll-booth attendant, often in a standing posi- tion. He reports having had hypertension in the past but takes no medication for it now. Physical examination: Blood pressure 194/102 mm Hg; pulse 64 bpm; respirations 16. Alert and oriented. Walks with slight limp. 2+ edema both ankles. Varicosities noted in both legs. Stasis der- matitis in ankles and calves. Ulcer present. Ankles and feet are cooler than calves. Pedal pulses faint but palpable, slightly stronger in left foot.