Fontaine Classification

Chronic lower-limb peripheral arterial disease — stage I to IV

Clinical stage

I — asymptomatic

IIa — mild claudication (pain-free walking > 200 m)

IIb — moderate–severe claudication (pain-free walking ≤ 200 m)

III — ischaemic rest pain

IV — ulceration or gangrene

Evidence

Original publication

Fontaine R, Kim M, Kieny R. Die chirurgische Behandlung der peripheren Durchblutungsstörungen (Surgical treatment of peripheral circulation disorders). Described the four-stage clinical classification of chronic lower-limb arterial insufficiency; stage II was later subdivided into IIa and IIb by walking distance.

Helvetica Chirurgica Acta, 1954

Open source

Guideline

The Rutherford categories (0–6) are the parallel classification used mainly in vascular surgery. ESC/ESVS and AHA/ACC peripheral arterial disease guidelines recommend confirming the diagnosis and severity objectively (ankle–brachial index, toe pressures, duplex/CT/MR angiography) and reserve the term chronic limb-threatening ischaemia for rest pain or tissue loss (Fontaine III–IV) with corroborating haemodynamics.

Last reviewed: 2026-09

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