Ischemic rest pain in obliterative arterial disease of the lower extremity is as informative diagnostically as is intermittent claudication. Specifically, ischemic rest pain is pain that occurs in the toes or in the area of the metatarsal heads. Occasionally, it occurs in the foot proximal to the metatarsal heads. Elevation of the limb above or at the horizontal position aggravates the pain and pendency, to some degree at least, brings relief. We have taught that no other pain is to be considered ischemic rest pain. Muscle cramps, for example, or any type of pain in the leg or thigh, no matter when it occurs, is not rest pain. We have, however, recognized one variant, and that is numbness of the toes brought on by the horizontal position and relieved by pendency. Our homespun explantation of ischemic rest pain to our students has been that the effective pressure is not sufficient