Presentation of Ischaemic Foot

The ischaemic foot may be divided into three clinical entities: the neuroischaemic foot, the critically ischaemic foot and the acutely ischaemic foot. The neuroischaemic foot is characterised by both ischaemia and neuropathy and complicated by ulcer. The perfusion is adequate to preserve the tissues intact in the absence of minor trauma and ulceration but cannot be increased sufficiently to heal an ulcer. In the critically ischaemic foot, perfusion is so poor that the integrity of the tissues of the foot is compromised by a global reduction in limb perfusion. Pain may be present in the foot although this depends on the degree of ischaemia and neuropathy. Without revascularization, the critically ischaemic foot will progress eventually to localised areas of ulceration and necrosis. In the acutely ischaemic foot, there is sudden interruption of limb perfusion with an onset of pallor, paraesthesiae, numbness and eventually paralysis and the foot becomes extremely cold. The severity of pain will depend on the degree of neuropathy.