This study was designed to compare the findings of noninvasive arterial testing in patients with and without diabetic foot pathology.

Combining the ABI (ankle brachial index) with TBI (toe brachial index) improved the ability to diagnose PAD (peripheral artery disease) in diabetic patients because the ABI has high specificity (low false positives) and the TBI has high sensitivity (low false negatives). The TBI was more reliable in patients with noncompressible arteries, medial artery calcinosis and/or neuropathy. Due to the relative incompressibility of calcified distal arteries in patients with DM, the ABI may be within normal limits in patients with PAD. This false negative result may lead surgeons to assume that normal perfusion is present.

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