Neurological & Vascular Assessment

A neurological and vascular foot assessment can be carried out on all patients with diabetes or those that have poor or reduced circulation and sensation in their feet and legs. The Dorsalis Pedis artery and Posterior Tibial artery are assessed using a doppler which can identify blocked or narrowed arteries that can lead to conditions such as stroke. Sensation is assessed using a 10mg monofilament pen. If the patient cannot feel the monofilament at certain specified sites on the foot, he/she has lost enough sensation to be at risk of developing foot ulcers due to the loss of protective sensation.

The ankle brachial pressure index (ABPI)  is calculated for the purpose of screening a patient for peripheral artery disease (PAD). It compares the blood pressure taken in the brachial artery of the arm with the blood pressure measured in the ankle or foot. This test is painless and non invasive, and can be a useful diagnostic tool if the podiatrist suspects that a patient may have peripheral artery disease.

To calculate the ankle brachial pressure index, the podiatrist  takes the patient's blood pressure in his arm, a procedure which many patients may be familiar with, and then repeats the test on the ankle. The ankle blood pressure is divided by the arm blood pressure to return a value. Values of 1.0 to 1.1 are indicators that the patient does not have peripheral artery disease. As the ankle brachial pressure index values drop below 1.0, it shows that the patient may be at risk or has peripheral artery disease, depending on how low the reading is.

This test is usually performed first while the patient is at rest, and then the patient is asked to use a treadmill for a few minutes so that the test can be repeated. In patients who do not have peripheral artery disease, the values should be the same with the second reading. If a patient is at risk or has peripheral artery disease, the ankle brachial pressure index after the treadmill session will be lower, showing that the blood is having difficulty reaching the legs.

If this diagnostic test reveals that a patient is at risk or has developed partial blockage in the arteries which supply the legs, the podiatrist can discuss treatment options. In patients who are simply identified as being at risk with their ankle brachial pressure index, some lifestyle changes may resolve the issue and prevent the onset of vascular disease.