Clinical vascular screening of the foot: For life and limb

Peripheral arterial disease (PAD) is asymptomatic in 50–75% of cases and tends to be underdiagnosed due to the inherent difficulties in screening. Accurate peripheral vascular testing is particularly important for those at highest risk of PAD, including older people and people with diabetes, renal disease or a history of smoking. Unfortunately, commonly used tests for PAD have limited sensitivity in these most at-risk populations. This article provides guidance to support early detection of PAD using evidence-based clinical tests. It also contains a flowchart as a clinical guide and a set of recommendations concerning the measurement of toe pressures. More targeted screening can reduce morbidity and mortality rates in people with PAD who are at high risk of cardiovascular events and who often remain undiagnosed.