American Podiatric Medical Association

View all recommendations from this society

Released January 19, 2022

Avoid ordering arterial segmental pressures of the lower extremities without toe pressures in patients with diabetes and foot ulceration.

Systolic ankle pressures can lack predictive validity for wound healing due to calcification of the ankle arteries. This is especially true of patients with diabetes and advanced complications where vessel calcifications are observed in 53–66% of patients. Compared to ankle pressures, toe pressures appear to be more predictive of distal arterial perfusion and wound healing potential in patients with diabetes. If toe pressures are requested at the time of the initial order, repeat studies performed solely for the purpose of obtaining toe pressures can be avoided.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

(1–5) The American Podiatric Medical Association’s (APMA) Clinical Practice Advisory Committee, consisting of APMA members, board members, young members and liaisons with special interests in a variety of subspecialty areas within podiatric practice, formulated the recommendations for the ABIM Foundation’s Choosing Wisely Campaign. The Committee worked with podiatric colleagues to create an initial list of recommendations, which was reviewed and narrowed down to eight recommendations. The list of eight recommendations was further developed and distributed to the Committee for ranking in numerical order. Committee members were asked to rank the recommendations based on their relevance, timeliness, strength of supporting evidence and appropriateness for inclusion in the Choosing Wisely Campaign. The rankings and deliberation enabled the Committee to come to the final five recommendations, which were again reviewed to ensure appropriate evidence was used to support each recommendation. The final recommendations were approved by the Board of Trustees of the APMA before submission to the ABIM Foundation.

(6–10) The American Podiatric Medical Association (APMA) tasked their Clinical Practice Advisory Committee consisting of APMA members, board members, young members, and liaisons with special interests in a variety of subspecialty areas within podiatric practice to formulate the recommendations for the ABIM Foundation’s Choosing Wisely Campaign. The Committee worked with podiatric colleagues to create an initial list of recommendations, which was reviewed and narrowed down to nine recommendations. The list of nine recommendations was further developed and distributed to the Committee for ranking in numerical order. Committee members were asked to rank the recommendations based on their relevance, timeliness, strength of supporting evidence and appropriateness for inclusion in the Choosing Wisely Campaign. The rankings and deliberation allowed the Committee to come to the final five recommendations, which were again reviewed to ensure appropriate evidence was used to support each recommendation. The final recommendations were approved by the Board of Trustees of the APMA before submission to the ABIM Foundation.

APMA’s disclosure and conflict of interest policy can be found at www.apma.org.

Sources

Potier L, Abi KC, Mohammedi K, Roussel R. Use and utility of ankle brachial index in patients with diabetes. Eur J Vasc Endovasc Surg. 2011;41(1):110-6.

Barshes NR, Flores E, Belkin M, Kougias P, Armstrong DG, Mills JL Sr. The accuracy and cost-effectiveness of strategies used to identify peripheral arterial disease among patients with diabetic foot ulcers. J Vasc Surg. 2016;64(6)1682-90.

Wang Z, Hasan R, Firwana B, Elraiyah T, Tsapas A, Prokop L, Mills JL Sr, Murad MH. A systematic review and meta-analysis of tests to predict wound healing in diabetic foot. J Vasc Surg. 2016;63(2 Suppl):29S-36S.

Brownrigg JR, Hinchliffe RJ, Apelqvist J, Boyko EJ, Fitridge R, Mills JL, Reekers J, Shearman CP, Zierler RE, Schaper NC, International Working Group on the Diabetic Foot. Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: a systematic review. Diabetes Metab Res Rev. 2016;32(Suppl 1):128-35.

Sharma A, Scammell BE, Fairbairn KJ, Seagrave MJ, Game FL, Jeffcoate WJ. Prevalence of calcification in the pedal arteries in diabetes complicated by foot disease. Diabetes Care. 2010;33(5):e66.