A 65-year-old man with known peripheral arterial disease (PAD) develops rest pain in the right foot and a 1.5 cm ulcer over the right heel. ABI is 0.35. He has Type 2 diabetes. This is classified as Rutherford category:

• A Category 3 (Severe claudication)
• B Category 4 (Rest pain)
• C Category 5 (Minor tissue loss) ✓
• D Category 6 (Major tissue loss)

Explanation

Rutherford classification of chronic limb ischaemia: Category 0 = asymptomatic; 1 = mild claudication; 2 = moderate claudication; 3 = severe claudication; 4 = ischaemic rest pain; 5 = minor tissue loss (non-healing ulcer, focal gangrene); 6 = major tissue loss (extending above transmetatarsal level). A 1.5 cm heel ulcer in the setting of critical limb ischaemia (ABI 0.35) represents minor tissue loss = Category 5. Rest pain alone without tissue loss = Category 4.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.