A regional pedal ischemia scoring system for decision analysis in patients with heel ulceration

Andrew T. Gentile, Scott S. Berman, Kurt R. Reinke, Christopher P. Demas, Daniel H. Ihnat, John D. Hughes, Joseph L. Mills

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


PURPOSE: The objective of this study was to evaluate patients undergoing operative debridement for heel ulceration and to categorize pedal perfusion and its influence on therapeutic alternatives. METHODS: Patients with heel ulceration were stratified by arteriography and graded I (patent posterior tibial, PT), II (occluded PT/reconstituted from peroneal), III (PT reconstituted from dorsal pedal), IV (no PT reconstitution but visible heel tributaries), and V (avascular heel). RESULTS: From May 1992 through January 1997, 23 patients underwent operative treatment for 25 heel ulcers. The heel ischemia score stratified patients into two groups: 1, revascularization/debridement (71% grades I to III, 29% grade IV, 0% grade V); and 2, free tissue transfer with or without revascularization (100% grades IV, V). Cumulative functional limb salvage was 91% (BP), 60% (BP+TT), and 81% (TT) at 24 months (P = 0.15 log rank). CONCLUSION: The heel ischemia score may direct treatment of heel ulceration by identifying patients who will need vascularized tissue transfer early in their treatment regimen.

Original languageEnglish (US)
Pages (from-to)109-114
Number of pages6
JournalAmerican journal of surgery
Issue number2
StatePublished - Aug 1998
Externally publishedYes

ASJC Scopus subject areas

  • Surgery


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