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The Regional Pedal Ischemia Score in a Patient with Ischemic Heel Ulceration

Description

Gentile et al developed a scoring system for evaluating patients with ischemic heel ulceration based on the changes seen with arteriography. This can help determine the optimum management for the patient. The authors are from the University of Arizona.


 

Parameters seen on arteriography:

(1) status of posterior tibial artery

(2) collateral flow to the posterior tibial artery

(3) other blood supply to the heel

Findings on Arteriography

Type

posterior tibial artery patent

I

proximal posterior tibial artery occluded, distal posterior tibial artery fills from peroneal artery

II

proximal posterior tibial artery occluded, distal posterior tibial artery fills from dorsalis pedis artery

III

proximal posterior artery occluded with no collaterals to distal posterior tibial artery, but visible tributaries seen extending to heel

IV

avascular heel

V

 

Patients with Types I, II or III can be managed by bypass alone.

 

Patients with Types IV or V require free tissue transfer with or without revascularization.

 


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Specialty

ICD-10