A04: Vascular Assessment of the At-Risk Limb

Peripheral artery disease is present in about half of diabetic foot ulcers and sharply raises the risk of non-healing and amputation. It is often silent, because neuropathy masks claudication and rest pain. The most familiar test, the ankle-brachial index, is least reliable in exactly these patients: medial arterial calcification falsely raises it, so a normal reading never excludes disease.

This module teaches the bedside toolkit in depth: pulse palpation and its poor reliability between examiners, the ABI, toe-brachial index and toe pressure, pedal Doppler waveforms, transcutaneous oximetry and skin perfusion pressure, and how to read them together when they disagree. It uses perfusion thresholds to estimate the chance of healing and the risk of amputation, supplies the Ischaemia grade for WIfI staging, and sets out referral by urgency, including chronic limb-threatening ischaemia. It does not cover treatment: revascularisation, bypass or endovascular choices and best medical therapy are taught in B02.

Content is tiered at Foundation, Core and Advanced level, with two algorithms and case vignettes. You receive the Teaching Document, the Evidence Base, the slide deck, a narrated video and an audio overview.