Synopsis
Recognise ischaemic rest pain and tissue loss, protect the foot and secure urgent multidisciplinary revascularisation assessment before preventable amputation.
- CLTI is chronic PAD with ischaemic rest pain, non-healing ulceration or gangrene; it replaces the older term critical limb ischaemia.
- Forefoot pain that is worse when supine and relieved by hanging the foot down is classic ischaemic rest pain.
- Tissue loss is often distal and punched out, with a cool hairless foot, delayed refill and reduced pulses; neuropathy may blunt pain.
Key red flags
Persistent forefoot/toe pain, often nocturnal and worse with elevation, relieved transiently by dependency; requires urgent vascular assessment.
Investigation priorities
Objectify PAD and describe arterial signals.
Management branches
Rest pain, non-healing arterial ulcer or gangrene without acute motor/sensory loss.
- First: urgent vascular MDT referral; document wound, pulses/Doppler, sensation, infection and analgesic needs.
- Next: protect the foot, avoid trauma and inappropriate compression, and obtain ABPI plus toe/waveform testing where needed.
Key medicines
Clopidogrel75 mg orally once daily.
Atorvastatin80 mg orally once daily for secondary prevention; use a lower dose if interactions, adverse-effect risk or patient preference require it.