[The clinical relevance and reproducibility of pedal pulse palpation]

The object of the present investigation was to investigate the diagnostic information which can be obtained by pedal pulse palpation. This is done by relating the findings on pulse palpation to the measured distal systolic blood pressure and comparison of these results with those of previous examinations where the connection between the distal systolic blood pressure and the prognosis is illustrated. In addition, the reliability of pulse palpation was assessed by an inter-observer investigation. Fifty four patients (average age 66 years) suspected of occlusive arterial disease participated in the investigation. Three observers undertook pulse palpation on the foot in a randomized sequence. The pulse in a foot was defined as the pulse in the dorsalis pedis artery and/or the pulse in the posterior tibialis artery. After this, the distal systolic blood pressure was measured in the patients with the strain gauge technique. Considerable inter-observer agreement was found (kappa-values between 0.66 and 0.76). Provided an observer found the pulse present, severe occlusive arterial disease could be excluded (ankle index less than 50%, toe pressure less than or equal to 30 mmHg). Absence of pulse in a foot provides a high probability for an ankle index less than or equal to 90% and thus a high probability for presence of occlusive arterial disease, but the extent of this cannot, however, be described.