Palpating pulses in the foot is part of the routine evaluation for blood flow. But what does it really mean in the diabetic foot? If pulses are palpable, does it mean that circulation is adequate? I have seen cases of poor wound healing and progressive gangrene in the presence of palpable pedal pulse.

I've listened to Gary Gibbons, MD (vascular surgeon, the Deaconess, Boston) on multiple occasions state that diabetic patients with a threatened limb require maximal flow to heal. I believe we have all seen patients like Dr. Liu describes. In a patient that presents with a new wound to my center, we always obtain non-invasive measures macrovascular flow (ABI, TBI, segmental pressures, PVR). I am surprised how often they don't correlate with the presence or absence of pulses. We often obtain microvascular measures as well (OxyVu, but TcPO2, SPP are adequate too). It is also surprising seeing the discordance between macro and micro vascular studies.

Also, remember about 8% of healthy patients have a non palpable DP pulse, and anatomical studies have shown the DP artery to be absent 2% of the time.

The issue at hand deals with micro vs. macro-circulation. The presence of palpable pulses is a good indicator of patent macro-circulation but I agree with Dr. Roger's that evaluation of the micro-circulation via TcPO2 and SPP is necessary when dealing with healing surgical or chronic wounds in patients with diabetes.

The key is to remember the presence of palpable pulses does not necessarily mean that there is enough local blood supply to heal a lower extremity ulceration.