Toe systolic pressures and toe-brachial indices: uses, abuses, and shades of gray

This article commences with arguments that toe systolic pressure (TSP) should be used as a means of diagnosing low blood pressure in relation to the prospect of wound nonhealing and amputation risk, that the toe-brachial index (TBI) should be used as a means of screening for peripheral artery disease, and that those specific uses for TSPs and TBIs should not be confused with each other. Problems associated with measurement of TSPs and TBIs are described, an attempt is made to establish abnormal threshold values for each, and tables are presented as aids to decision making while also indicating the need to take uncertainties into account. A possible role for TBIs in monitoring pedal vascular supply is given consideration.