Palpating Ankle Pulses is Insufficient in Detecting Arterial Insufficiency in Patients with Leg Ulceration

Palpation of pedal pulses by community nurses is a poor predictor of leg arterial disease and must be used in combination with Doppler ankle-brachial pressure index.

Abstract

Objective: To investigate the ability of district nurses to detect lower limb arterial disease by palpation of ankle pulses. Design: Ankle pulse palpation of patients presenting with ulcerated limbs and comparison with Doppler ankle-brachial pressure index (ABPI). Patients: Sequential patients presenting to community ulcer clinics. Main outcome measure: Sensitivity and specificity of pulse palpation to detect arterial disease compared with ABPI. Results: Of 533 limbs with ulceration in 462 patients (mean age 74 years, 67% female), 167 (31%) had no detectable pulses at the ankle. Of the 93 limbs with ABPI <0.9, 34 (37%) had detectable pulses. Of those limbs with ABPI ≥ 0.9, 108 out of 440 (25%) had no detectable ankle pulses. Sensitivity for lack of pulses as a predictor of arterial disease (ABPI <0.9) was 63% with a specificity of 75% and positive predictive value of only 35%. Using only the absence of palpable pulses would lead to 37% of patients with arterial disease being treated inappropriately. Conclusion: Palpation of pedal pulses by community nurses is a poor predictor of leg arterial disease and must be used in combination with ABPI. Only when significant arterial disease is excluded should compression be applied.