Transcutaneous Doppler ultrasound in the prediction of healing and the selection of surgical level for dysvascular lesions of the toes and forefoot.

Dysvascular lesions of the toes and forefoot are divided into 5 grades and matched with appropriate treatment programs. Patients with diabetes mellitus and arterosclerosis obliterans make up the greatest number presenting with such problems. Transcutaneous Doppler ultrasound has been added to clinical criteria as an aid in the prediction of healing. Systolic blood pressures are taken at the thigh, knee, calf, ankle, foot and toes using transcutaneous Doppler ultrasound as a sensitive stethoscope. Systolic blood pressure taken at the antecubital fossa is divided into the lower extremity pressures to obtain an ischemic index. Healing can be predicted with 90% or better accuracy where the ischemic index is above 0.35 in the arteriosclerotic foot and above 0.45 in the diabetic foot.