Myotonic dystrophy complicated by peripheral vascular disease.

Case report A 40-year-old man was admitted to a surgical unit with a 3-week history of increasing pain in the right foot. In the past year he had experienced pain in both calves on walking half a mile, and in addition, had been falling frequently, his legs '6;ving way'. He had had bilateral cataract extractions on,., year previously. There was no history of diabetes melitus or medication. He was an unmarried, unemploye'd labourer, a non-smoker but a drinker of at least t%,3 pints of beer thrice a week. There was no relevant 'r.mily history available. On examination, he had the characteristic featu; es of myotonic dystrophy (Fig. 1), including sternomastoid, facial and distal limb weakness and wasting, plus percussion myotonia. There was also hypogonadism and gynaecomastia. The pulse was irregular, the blood pressure 125/90 mmHg. Peripheral pulses were absent below the femorals bilaterally. The right foot was the cooler and there was ischaemic gangrene affecting the great toe (Fig. 2).