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

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.