Enhancing PAD Detection: Introducing the Toe Brachial Index (TBI) to Our Community Screenings

Written By Katelyn Jackson

Peripheral artery disease (PAD) is a common yet often overlooked condition where the arteries in the legs become narrowed or blocked, leading to reduced blood flow. This can result in symptoms like leg pain, cramping, or non-healing wounds. If untreated, PAD can significantly increase the risk of heart attack, stroke, and other serious complications.  In the most advanced stages, PAD can lead to amputation of the toes or leg.  Early detection is essential for effective management and treatment. However, many patients, especially those in underserved areas, face challenges in accessing specialty vascular care, leading to delayed diagnosis and treatment. Research has shown that "vascular care deserts" – regions with limited access to vascular care – are often home to populations that are geographically isolated, disadvantaged, and unaware of their health conditions. To address these gaps, targeted outreach programs, guided by geospatial analysis, are crucial. One valuable tool for diagnosing PAD in these settings is the Toe Brachial Index (TBI). The TBI is a simple, non-invasive, and affordable test that assesses blood flow in the toes, making it particularly useful in mobile clinics and community screenings.

What is the Toe Brachial Index (TBI) and how is it performed?

The TBI measures the blood pressure in your toe and compares it to the blood pressure in your arm. By placing a small cuff around the toe and using a Doppler device, the TBI provides a ratio that helps determine blood flow to the toes.  A lower TBI value suggests poor circulation in the toes which aids in diagnosing PAD.

Comparing TBI vs. Ankle Brachial Index (ABI)

The Ankle Brachial Index (ABI) is a well-established method for diagnosing PAD by comparing blood pressure in the ankle to that in the arm. Recent research shows that the TBI is equally effective in detecting PAD. One advantage to TBI is the ability to obtain a more accurate pressure in the toe when larger arteries in the ankle may have too much calcium to compress and get an accurate pressure, particularly in patients with diabetes or who are on dialysis. Nevertheless, ongoing research is needed to further validate the TBI’s effectiveness across different patient groups.

Volunteers using the Koven vascular Doppler to check the TBI during screenings.

We are excited to integrate the Toe Brachial Index (TBI) into our community screenings, particularly in areas where access to vascular care is limited. This advanced, portable, and user-friendly tool will enhance our ability to detect PAD early, providing a critical opportunity for timely intervention. The TBI's simplicity and non-invasive nature make it accessible even to those unfamiliar or uncomfortable with medical testing. By identifying individuals who may have PAD before symptoms appear, we can initiate preventative care that may avoid progression of disease. Dedication to early detection and outreach efforts in underserved populations, such as the CHAMPIONS initiative, will help ensure that everyone in our community has the chance to achieve better vascular health.

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Katelyn Jackson
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