The ankle brachial index test is used to detect poor circulation in the lower legs caused by clogged arteries. “Peripheral Arterial Disease,” or PAD, reduces the flow of blood to the lowest part of the body and creates a risk of heart disease, aortic aneurysms and stroke. It is a condition similar to coronary artery disease, which restricts the flow of blood to the heart, and carotid artery disease, which restricts the flow of blood to the brain. 

People with PAD are at increased risk for heart disease and strokes. PAD can also be an indicator of diabetes, hypertension and other conditions.

The ABI test is simple. It uses uses a standard blood pressure cuff and a special ultrasound stethoscope called a Doppler. The pressure in the ankle is compared to the pressure in your arm to determine how well the blood is flowing and whether additional testing is needed.

Early detection of peripheral arterial disease can help prevent amputation, heart attack and stroke.

Peripheral Arterial Disease of the arteries that affects 10 million Americans. It can affect anyone regardless of age but is most common in men and women over the age of 50. Over the age of 65 it affects as much as 20 percent of the population.

A toe brachial index test is done to check circulation of the legs. This is usually done if an ankle brachial index (ABI) is abnormal or inconclusive. The procedure is similar to an ABI, but instead of placing a blood pressure cuff on the ankle, a small cuff is placed on the big toe. The pressure in the arm is compared to the pressure in your toe to determine how well the blood is flowing and whether additional testing is needed. This test is done to check for peripheral arterial disease (PAD). Symptoms may include leg pain and claudication, which is explained below.


Claudication is leg pain that may feel like cramping. It occurs when normal blood flow to the muscles is disrupted. This type of pain gets worse when walking or with activity and improves at rest. Sometimes, if the blood flow is severely compromised, pain can occur at rest, too.

Peripheral artery disease is a common cause of claudication. This is a hardening of the arteries of the legs from plaque build up in the arteries of the legs. When there are blockages, blood is not able to flow to the muscles of the legs like normal. Walking causes the muscles to require more blood flow, and blockages do not allow the blood flow increase. This causes pain like cramping, aching, and burning.

Testing such as ankle brachial index and toe brachial index are good screening tools for peripheral artery disease. Ultrasounds and CT scans are more detailed, less invasive studies that give physicians a better idea of where blockages are located. Peripheral angiogram is done at the hospital and uses dye to see if blockages need to be fixed. They can be fixed with angioplasty, such as balloons, stents, and lasers.