Fontaine classification

Stage I – Asymptomatic. Of note: Fontaine stage I does in fact describe patients who are for the most part asymptomatic. Careful history may actually reveal subtle and non-specific symptoms such as paresthesias. Physical examination may reveal cold extremities and other signs of “subclinical” peripheral artery disease. More examples include bruits over blood vessels and lack of normal pulses.

Stage II – Intermittent claudication. This stage takes into account the fact that patients usually have a very constant distance at which they have pain:

• Stage IIa – Intermittent claudication after more than 200 meters of pain free walking.

• Stage IIb – Intermittent claudication after less than 200 meters of walking

Stage III – Rest pain. Rest pain is especially troubling for patients during the night. The reason for this is twofold: First, the legs are usually raised up on to a bed at night, thus diminishing the positive effect gravity may have had during the day when the legs were dependent. Second, during the night the lack of sensory stimuli allow patients to focus on their legs.

Stave IV – Ischemic ulcers or gangrene (which may be dry or humid).