The office Doppler can be an invaluable aid to
diagnosing PAD. The ABIs , PPG waves and hallux
pressures provides significantly more
information about the vascular status of a
patient then can be determined by just feeling
the patient's pulses. Some patients will not
have any ulcers and have a lot of foot pain
which is not from an ingrown big toenail,
neuroma or other podiatry problem, but is PAD.
It is important to determine the vascular status
which can be a real challenge especially in the
geriatric and diabetic population. The podiatric
history can be very helpful, however, sometimes
on rare occasions a patient could be able to
walk without claudication pain and still have
insufficient circulation to have foot surgery.
Sometimes the patient has swelling in the feet
and it is difficult to get an accurate
assessment of the pulses by using your hand.
While low ABIs are a good indication of PAD,
there are a few cases especially diabetic
patients who have calcified vessels where a
patient could have pulses that appear to be
normal, but there is small vessel disease and
the patient would not be able to heal or have
difficulty healing from even the most minor
surgical procedures.
I have had non-diabetic patients in their 50's
who appear to have normal pulses and have
essentially normal ABIs but have significant
small vessel disease as suggested by
insufficient PPG waves and poor hallux pressures
as measured by Doppler readings and confirmed
from a CTA test. I send all my PAD patients to
vascular surgeons who can usually restore the
circulation using vascular procedures and/ or
medications. Patients can in some cases, if
there are painful foot problems, have the
corrective foot surgery. I am very gratified
because by having the vascular surgeon improve
the circulation, the vascular intervention
and/or medications usually can delay future
problems and extend patients' lives.
Ed Cohen, DPM, Gulfport, MS, ECohen1344@aol.com
