Assessment
Table 1. Interpretation of the Results of Ankle-Brachial
Index Measurement
Ankle-Brachial Index (ABI)a
Interpretation
> 1.30
Poorly compressible vessels, arterial calcification
0.90-1.30
Normal
0.60-0.89
Mild arterial obstruction
0.40-0.59
Moderate arterial obstruction
< 0.40
Severe arterial obstruction
a
Obtained by measuring the systolic blood pressure (using a properly sized sphygmomanometer) in
the ankle divided by that in the brachial artery. The presence of arterial calcification can lead to an
overestimate in the index.
Consultation
ÎFor both outpatients and inpatients with a DFI, provide a well-coordinated
Î
approach by those with expertise in a variety of specialties, preferably
by a multidisciplinary diabetic foot care team (SR-M).
Note: Where such a team is not yet available, the primary treating clinician should
coordinate care among consulting specialists.
ÎÎDiabetic foot care teams can include (or should have ready access to)
specialists in various fields. Patients with a DFI may especially benefit
from consultation with an infectious disease or clinical microbiology
specialist and a surgeon with experience and interest in managing
DFIs (SR-L).
ÎÎClinicians without adequate training in wound debridement should
seek consultation from those more qualified for this task, especially
when extensive procedures are required (SR-L).
ÎÎIf there is clinical or imaging evidence of significant ischemia in
an infected limb, consult a vascular surgeon for consideration of
revascularization (SR-M).
ÎÎClinicians unfamiliar with pressure off-loading or special dressing
techniques should consult foot or wound care specialists when these
are required (SR-L).
ÎÎIn communities with inadequate access to consultation from
specialists, consider devising systems (eg, telemedicine) to ensure
state-of-the-art patient management (SR-L).
1
