I met a new patient about a month ago with a non-healing ulcer on her right foot. She was a smoker, but not diabetic. I was concerned about peripheral vascular disease. She had a CT angiogram with good run off….after an extensive work up, it turns out that she has scleroderma with severe pulmonary hypertension….she has since had a transmetarsal amputation of her right forefoot….and after it heals rheumatology will begin immunosuppressive therapy. My take away was to remember that common things are common, but keep the rarer things in the back of your mind…..