Active pedal plantarflexion: A hemodynamic measurement of claudication

The noninvasive evaluation of patients with claudication often requires the use of adjunctive noninvasive testing to differentiate true vascular claudication from other disease processes. Currently, postocclusion reactive hyperemia (PORH) is occasionally utilized for quantitatively assessing the peripheral circulation in place of treadmill testing. Active pedal plantarflexion (APP) may be a better method for the objective evaluation of claudication, by providing a more physiological stress. APP is presently employed in many vascular laboratories; however, no standards exist for determining what constitutes an abnormal examination. All patients presenting for lower extremity noninvasive vascular evaluation over a 2-month period, without tissue loss, rest pain, or noncompressive vessels, were evaluated with both postocclusion reactive hyperemia and active pedal plantarflexion (25 patients). Selected patients were also evaluated with treadmill testing (5 patients). Both PORH and APP yielded similar results in patients with periferal vascular disease (PVD) who tolerated both procedures, with a mean fall in absolute pressure of 48.8 and 48.9 mmHg, and a fall in ankle brachial index (ABI) of 49.6% and 49.9%, respectively. However, APP was better tolerated by patients. Twelve patients experienced difficulty with PORH, with six patients unable to complete the evaluation. Only three patients experienced difficulty with APP, with only two patients being unable to complete the examination. APP and treadmill had 100% concordance in determining the presence of true vascular claudication. Active pedal plantar- flexion is a good noninvasive method for the evaluation of vascular claudication. It can be performed in a very short period of time without the expensive, bulky equipment required for treadmill testing. APP is better tolerated than PORH and treadmill and provides a more physiologic stress than PORH, reproducing patient symptoms that can be correlated with the objective findings. APP is a useful method of noninvasive evaluation of patients with claudication.