The comprehensive assessment of vascular supply to the diabetic foot begins like all assessments, with a good vascular history followed by physical examination and appropriate imaging studies.

Basic screening of the diabetic patient should include palpation of the dorsalis pedis and posterior tibial pulsations.  Regardless of the presence or absence of either dorsalis pedis or posterior tibial artery pulses patient the next step should always include evaluation of the ankle brachial index.  Ankle-brachial index pressure testing is a simple, point-of-care test for screening for peripheral arterial disease.  Ankle-brachial index test is simply performed measuring blood pressures in the arms at the brachial artery and the blood pressure at the ankle either at the dorsalis pedis or posterior tibial arteries.  A full overview of the ankle brachial index test can be found by clicking here.  Ankle brachial index testing in the diabetic patient unfortunately can sometimes be misleading due to medial calcinosis of the arteries leading to noncompressible studies.  In the presence of noncompressible studies, which are identified by an ABI greater than 1.3 toe pressures, transcutaneous oximetry, or skin perfusion pressure testing can be used.

In a patient that has screened positive for arterial disease by an ankle-brachial index, other confirmatory tests to further define the level of the extent of obstruction can be performed.  Segmental limb pressures with pulse volume plethysmography in arterial ultrasonography are just some of the options can be performed in the vascular laboratory.