Clinical relevance of pedal pulse palpation in patients suspected of peripheral arterial insufficiency.

Abstract

Previous studies in patients with peripheral arterial disease (PAD) have shown that the prognosis is relatively good when the distal systolic ankle index (ankle systolic pressure/arm systolic pressure) is above 50% and the distal toe systolic pressure is above 40 mmHg. In 132 patients suspected of PAD in the legs we investigated the relationship between the presence of pedal pulse and the distal systolic pressure in order to discover what diagnostic and prognostic information could be found from pulse palpation alone. The prospective study consisted of three consecutive series (A, 51 patients; B, 42 patients; and C, 39 patients); three of the authors palpated the arteries of the patients' feet: one author in each series. The palpatory findings were related to the distal systolic pressures. When pedal pulses were present we found: (a) ankle indices above 50%; and (b) toe systolic pressures above 40 mmHg. These minimal pressure values were reproducible in the three series. Furthermore, patients lacking palpable pulses in both feet had ankle indices below 90%. We conclude: (a) if pulses are palpable on both feet of a patient the prognosis for progression is relatively good regarding the patient's PAD; (b) if pedal pulse is palpable an arteriosclerotic ulcer on the foot will heal; and (c) patients lacking palpable pulses in both feet actually suffer from PAD.