Assessing the vascular status of the feet in patients with diabetes

Diabetes mellitus is a signifi cant
risk factor for the development
of peripheral arterial disease
(PAD) (Baker et al, 2005).
Figures suggest that PAD
occurs 20 times more often in
people with diabetes compared
with the non-diabetic population
(Shaw and Boulton, 2001)
and is known to be a major
risk factor for diabetic foot
ulceration. Of all lower extremity
amputations, 40–70% are
related to diabetes, with the
majority occurring as a result
of PAD (Apelqvist et al, 1992;
International Working Group on
the Diabetic Foot, 2005).
There is a general consensus
that diabetic patients should
receive regular vascular
assessment to allow early
identifi cation of vascular
changes and prompt
intervention to prevent
deterioration (International
Working Group on the
Caroline McIntosh is Senior Lecturer in Podiatry, University of Huddersfi eld, Yorkshire
A reduced blood supply to the lower limb, due to arterial disease, is a common cause of foot
ulceration in patients with diabetes. Early identifi cation of arterial disease allows the implementation
of prompt management strategies to prevent adverse outcomes, such as ulceration. Regular vascular
assessment is therefore essential to establish the patient’s risk of ulcer development. This article will
now examine the important aspects of lower-limb vascular assessment.
Diabetic Foot, 1999; Scottish
Intercollegiate Guidelines
Network [SIGN], 2001; National
Institute for Health and Clinical
Excellence [NICE], 2004).
This article provides advice
based on current clinical
guidelines to assist practitioners
when undertaking vascular
assessment of the diabetic foot.