Second Toe Systolic Pressure Measurements are Valid Substitutes for First Toe Systolic Pressure Measurements in Diabetic Patients: A Prospective Study

Bhamidipaty, Venu; Dean, Anastasia; Yap, Sing-Chien; Firth, John D.; Barron, M.; Allard, Bernard P; Chan, Steven

doi:10.1016/j.ejvs.2014.09.011

Cited by 19 publications

(8 citation statements)

References 19 publications

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“…A parallel range of procedures exists for the measurement of TBIs, including which arms and toes blood pressures are taken from, the size and location of toe cuffs, and whether or not pressure readings are averaged (McAra & Trevethan, 2018). Some of these procedures have been demonstrated to yield substantially different outcomes (Bhamidipaty et al, 2015;Påhlsson et al, 2007).…”

Section: Issues Pertaining To Screening Testsmentioning

confidence: 99%

Screening, Sensitivity, Specificity, and So Forth: A Second, Somewhat Skeptical, Sequel

Trevethan

2019

MHS

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This article is concerned with the sensitivity, specificity, predictive values, and other metrics associated with screening tests. It has direct origins in two previous articles. In this third article, the author of the first article writes about topics and issues that were addressed only minimally in his previous article and expands on topics raised by authors of the second article. In particular, attention is turned to wording and terminology that can be idiosyncratic and confusing with regard to screening versus diagnosis as well as to issues associated with reference (“gold”) standards and screening tests, and to the importance of cutpoints and prevalence in relation to metrics associated with screening tests. The primary aims are to help readers attain clarity about topics that they might have felt unsure about; gain reassurance about conceptual difficulties in the field that, once recognized for what they are, can become less problematic because it is possible to be confident about not being confident; and, where appropriate, adopt an appropriately skeptical attitude about screening tests and their associated metrics. Examples are drawn from the use of ankle–brachial and toe–brachial indices for identifying peripheral artery disease, although wider applicability is intended.

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Section: Issues Pertaining To Screening Testsmentioning

confidence: 99%

Screening, Sensitivity, Specificity, and So Forth: A Second, Somewhat Skeptical, Sequel

Trevethan

2019

MHS

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“…TP measurement of the second toe has been validated as a surrogate for the first toe 8 . Utilising the second toe resulted in a reduction to 12.9% (52/403) of limbs with prohibitive tissue loss or absence of both the first and second toe ( n = 44) or forefoot amputation ( n = 8).…”

Section: Resultsmentioning

confidence: 99%

A substantial number of patients with rest pain, ulceration or gangrene are unable to undergo current non‐invasive perfusion testing—Could another modality be utilised?

Hart,

Hong,

Lee

et al. 2023

Wound Repair Regeneration

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Rest pain, ulceration and gangrene are hallmark features of chronic limb‐threatening ischaemia (CLTI). Wound healing can be challenging, and this is compounded by an inability to measure lower limb perfusion via non‐invasive tools such as toe pressure (TP). Novel perfusion tests, such as pedal acceleration time (PAT), may overcome some limitations. This study aimed to quantify the proportion of patients with CLTI that were unable to undergo TP measurement. Over a three‐year duration, 344 consecutive patients with CLTI underwent PAT assessment (403 limbs). Overall, 32% of limbs were unable to undergo first toe TP, and 12.9% were unable to undergo first and second toe TP due to forefoot/digit amputation or tissue loss. Inability to measure first toe TP disproportionately impacted CLTI patients with diabetes compared to patients without diabetes (39.6% limbs (106/268); vs. 17% limbs (23/135); p < 0.001). Novel modalities may provide a useful tool for assessing perfusion in CLTI.

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“…1,2 So far, studies comparing TBP on the first and second toe have been performed in diabetic patients demonstrating strong correlation between the toes with pulse oximeter 10 and with photoplethysmography. 11 Moreover, Watanabe et al 12 demonstrated interchangeability of TBP on the first and second toe with oscillometric technique in a retrospective study of 57 patients where most of the patients were free from peripheral arterial disease. Our results, thus, are the first that explore the interchangeability between the first and second toe using laser Doppler as flow detector and in a mixed population with various stages of peripheral arterial disease.…”

Section: Discussionmentioning

confidence: 99%

Laser Doppler Measurements of Systolic Blood Pressure on the First and Second Toe in Patients with Peripheral Arterial Disease

2021

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Laser Doppler was used to measure toe blood pressure (TBP) in 40 consecutive patients with various degree of peripheral arterial disease. The aim of this methodological study was to increase the usefulness of TBP by exploring the interchangeability between TBP from the first and second toe and by investigating daily routine reproducibility and measurement variability. According to our study design pressure values were based on three measurements that were averaged. At simultaneous measurements, TBP of the first toe was 71 mm Hg (standard deviation [SD] 25) compared with 70 mm Hg (SD 25) on the second toe. The correlation (r) between first and second toe pressure measurements was 0.84 and intraclass correlation coefficient (ICC) was 0.84. The difference between TBP on the first and second toe was not related to gender, diabetes, or magnitude of the pressures. Repeated TBP measurements of the right first toe after disconnection of cuffs, 5 to 10 minutes rest, and reconnection of cuffs had a coefficient of variation (CV) of 9% and an ICC of 0.93. CV for toe-brachial index (TBI) was 8%. Our results show that measurements of TBP from the second toe to a large extent are interchangeable with those assessed from the first toe and can be used in clinical situations where measurements from the first toe are not feasible. Flow detection with three averaged laser Doppler measurements generates TBP and TBI with low variability.

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Second Toe Systolic Pressure Measurements are Valid Substitutes for First Toe Systolic Pressure Measurements in Diabetic Patients: A Prospective Study

Abstract: This is the first study which demonstrates that second toe systolic pressures are interchangeable with those of the first toe. Second toe pressures can be used in diabetic patients whose first toe pressures cannot be assessed.

Cited by 19 publications

References 19 publications

Screening, Sensitivity, Specificity, and So Forth: A Second, Somewhat Skeptical, Sequel

Screening, Sensitivity, Specificity, and So Forth: A Second, Somewhat Skeptical, Sequel

A substantial number of patients with rest pain, ulceration or gangrene are unable to undergo current non‐invasive perfusion testing—Could another modality be utilised?

Laser Doppler Measurements of Systolic Blood Pressure on the First and Second Toe in Patients with Peripheral Arterial Disease

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