If ulcers in the neuroischaemic foot fail to heal despite optimal treatment, the reason may be ischaemia. Atherosclerotic lesions commonly occur in the tibial arteries but also occur in the popliteal and femoral arteries, with the iliacs rarely involved. A careful vascular assessment is necessary, to determine the degree of ischaemia and to decide when to perform invasive investigations with a view to revascularization.
Initially the ankle brachial pressure index should be measured, supplemented by assessment of the Doppler waveform. Further tests such as measurement of transcutaneous oxygen tension and toe pressure may be helpful in deciding whether to pursue invasive arterial investigations with a view to vascular intervention.
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