Can You Obtain a Toe-Brachial Index (TBI) on Patients with Toe Wounds?
Yes, you can and should assess for peripheral arterial disease in patients with toe wounds, but the toe-brachial index (TBI) may not be feasible if the wound involves the digit where the pressure cuff would be placed; in such cases, use alternative vascular assessment methods. 1
Vascular Assessment is Critical
- All patients with foot wounds, including toe wounds, require evaluation for arterial ischemia as part of the comprehensive limb assessment 1
- The 2024 ACC/AHA guidelines emphasize that adequate perfusion is a fundamental component of wound care for lower extremity wounds 1
- Vascular assessment should include evaluation of palpable pedal pulses, ankle-brachial index (ABI), and when indicated, toe pressures 1
When TBI is Feasible
- TBI can be performed on unaffected toes if the wound is localized to one or two digits, allowing measurement on the remaining toes 1
- A toe pressure >45 mmHg or ankle pressure >80 mmHg predicts better healing outcomes 1
- Transcutaneous oxygen tension (TcPO2) >40 mmHg is another predictor of successful wound healing 1
Alternative Assessment Methods When TBI is Not Possible
- Use ankle-brachial index (ABI) as the primary screening tool when toe wounds prevent TBI measurement 1
- Assess for palpable pedal pulses (dorsalis pedis and posterior tibial arteries) 1
- Consider transcutaneous oxygen measurement (TcPO2) as an alternative perfusion assessment 1
- Refer for vascular imaging or consultation if clinical signs suggest ischemia regardless of ability to obtain TBI 1
Clinical Context for Toe Wounds
- Toe wounds in diabetic patients require prompt evaluation as they can rapidly progress to infection and may involve underlying osteomyelitis 1, 2
- Adequate perfusion assessment guides whether revascularization is needed before or concurrent with wound treatment 1
- Poor perfusion (absent pulses, low pressures) may necessitate vascular intervention before definitive wound management 1
Key Pitfall to Avoid
- Do not delay vascular assessment simply because direct TBI measurement is impractical - use alternative methods and maintain a low threshold for vascular surgery consultation 1
- Wounds that are poorly perfused, deep, large, or necrotic require more aggressive evaluation and often surgical intervention 1