Assessment
Table 1. Interpretation of the Results of Ankle-Brachial Index Measurement
Ankle-Brachial Index (ABI)a > 1.30
0.90-1.30 0.60-0.89 0.40-0.59 < 0.40
a Interpretation
Poorly compressible vessels, arterial calcification Normal
Mild arterial obstruction
Moderate arterial obstruction Severe arterial obstruction
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 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.
ÎDiabetic 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).
ÎClinicians without adequate training in wound debridement should seek consultation from those more qualified for this task, especially when extensive procedures are required (SR-L).
ÎIf there is clinical or imaging evidence of significant ischemia in an infected limb, consult a vascular surgeon for consideration of revascularization (SR-M).
ÎClinicians unfamiliar with pressure off-loading or special dressing techniques should consult foot or wound care specialists when these are required (SR-L).
ÎIn communities with inadequate access to consultation from specialists, consider devising systems (eg, telemedicine) to ensure state-of-the-art patient management (SR-L).
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