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Glyceryl trinitrate (GTN) causes predictable vasodilation by the donation of nitric oxide, which causes relaxation of the endothelium of blood vessel walls.This substance has been in pharmacologic use since 1870 and is a first-line treatment for angina pectoris.Studies involving normal vasculature as well as diseased vascular states are consistent in demonstrating GTNs significant vasodilatory effects on both systemic and peripheral systems.Topical GTN for pedal and digital ulceration has received little attention in the literature to date.Exceptions include some case studies documenting remarkably positive outcomes in cases of severe ischaemic ulceration of fingers (Lund et al 1948, Wheeland et al 1983).GTN has been successfully applied to other clinical problems involving perfusion of the extremities such as Raynauds phenomenon (Herrick 2009, Anderson et al 2002).A significant body of existing literature on the efficacy of GTN for a wide range of non-podiatric uses suggests an untapped potential for applications of GTN to the problems of vascular perfusion of the foot.GTN may relieve symptoms of ischaemia (Fletcher et al 1997) and be useful in cases with borderline vascular supply that require a boost to perfusion to enable healing (McAra 2011).This novel application of a proven therapy which that may have the potential for reducing amputations associated with peripheral vascular disease (PVD) holds great clinical interest and may yield important implications for PVD management.Other literature evaluates GTN in the management of Painful Diabetic Neuropathy (PDN).This application is of particular interest as a potential adjunct to treatment options for the prevalent and difficult clinical challenge of PDN (Rayman et al 2009, Agrawal 2003).Important issues with this drug involve discernment of appropriate applications, queries over its use in diabetic ulceration, contraindications for use on vascular leg ulcers, dose regimes and a discussion of potential side effects and drug tolerance.A six-month randomised controlled study involving 100 non-diabetic and diabetic study subjects with PVD is currently in progress.Vascular and neurological measurements including pain scores are being correlated with skin temperatures and climatic temperatures.The study includes monitoring of vascular toe pressures using automated photoplethysmography (PPG), which is a clinically accessible, validated method to assess pedal perfusion (Perez-Martin et al 2010).Early result trends are emerging which will be presented at this conference.