Palpable Pedal Pulses Research Articles

Reliability of Palpation of Pedal Pulses As Ascertained by the Kappa Statistic

An improved statistic (weighted Kappa) was tested for reviewing the reliability of the palpation of pedal pulses by three observers. Significant improvement was noted after training. Reliability also persisted with respect to a reduced form of the conventional ordinal grading system. The findings indicated that problems of usefulness or reliability may arise when more than five distinctions are made in describing the pulses or when the data are completely reduced to only a dichotomous (present-absent) system.

On diabetic osteopathy: a radiographic study of 21 patients.

Twenty-one diabetic patients with anesthetic peripheral neuropathy who never suffered a foot infection or local ulceration had roentgenograms of both feet to seek whether osseous changes characteristic of diabetic osteopathy were present. We found nine patients with vascular calcification (all 21 patients had palpable pedal pulses); four patients with ancient fractures; one patient with two phalangeal erosions; and two patients with equivocal osseous cystic lesions. No patient had findings typical of diabetic osteopathy. From this study, plus experience with other diabetic patients who had infected, ulcerated feet, we conclude that diabetic osteopathy represents healing or healed lesions of local osteomyelitis.

AMPUTATION OF THE TOES FOR VASCULAR DISEASE: FATE OF THE AFFECTED LEG

53 patients coming to amputation of one or more toes for the late results of degenerative vascular disease were studied prospectively. By a median time of thirteen months, 26 of the 53 had undergone a major amputation on the affected side. Diabetes was associated with the same prognosis as atherosclerosis obliterans uncomplicated by diabetes. A palpable pedal pulse or a functioning arterial reconstruction carried a virtual guarantee of success for the toe amputation. The presence of a popliteal pulse, however, was not associated with any better prognosis than the presence of a femoral pulse alone. Smoking seemed to exert little influence. With the passage of time, the major-amputation rate rose steadily, and by 3 1/2 years almost three-quarters of the patients had come to major amputation.

Pedal Pulses Disappearing with Exercise

THE association of intermittent claudication with obstructive atherosclerosis is well recognized. However, the presence of readily palpable pedal pulses easily deters one from considering atherosclerosis and arterial occlusion as the cause of claudication. Actually, significant partial to complete obstruction of an artery may be associated with palpable distal pulses. Exercise to the point of claudication causes these pulses to disappear, with a gradual return with rest, whereas normally the peripheral pulses remain unchanged or increase with exercise. Although this phenomenon has been reported1 2 3 its value in screening patients with symptoms suggestive of intermittent claudication has not been generally recognized.Thirteen . . .