The Significance of Toe-Brachial Index in Assessing Peripheral Artery Disease, Cardiovascular Disease, and Peripheral Neuropathy
March 17, 2026
Introduction:
Peripheral artery disease (PAD), cardiovascular disease (CVD), and peripheral neuropathy are prevalent medical conditions that can lead to severe complications if left undiagnosed and untreated. Early detection is crucial for optimal management and prevention of these conditions. The Toe-Brachial Index (TBI) serves as a valuable diagnostic tool in this context.
PAD and Toe-Brachial Index:
PAD is a circulatory disorder characterized by the narrowing or blockage of peripheral arteries due to atherosclerosis. It predominantly affects the lower extremities, leading to reduced blood flow and potential tissue ischemia. TBI, which is the ratio of systolic blood pressure at the toe to that in the brachial artery, is a reliable method for evaluating PAD in patients with lower extremity symptoms.
Numerous studies have demonstrated the utility of TBI in diagnosing PAD, with a TBI value of ≤0.70 being indicative of the presence of PAD.4
TBI has also been shown to correlate well with more invasive diagnostic methods, such as angiography.5
Cardiovascular Disease (CVD) and Toe-Brachial Index:
CVD is a class of disorders affecting the heart and blood vessels, including coronary artery disease, heart failure, and stroke. PAD often coexists with CVD, as both share similar risk factors, such as smoking, hypertension, dyslipidemia, and diabetes.1 Studies have shown that patients with PAD have an increased risk of adverse cardiovascular events.2 TBI, as a diagnostic tool for PAD, can also help identify patients at high risk of CVD and prompt further evaluation and management to reduce morbidity and mortality.3
Peripheral Neuropathy and Toe-Brachial Index:
Peripheral neuropathy is a common complication of diabetes and other systemic disorders, characterized by damage to peripheral nerves, leading to loss of sensation, pain, or motor dysfunction.4 Diabetic patients with peripheral neuropathy are at a higher risk of developing PAD, and the presence of both conditions can complicate the diagnosis and management of foot ulcers.5 TBI has been found to be a useful tool for assessing vascular status in patients with peripheral neuropathy, aiding in the identification of those at risk for PAD and optimizing their treatment.6
Recent advances in TBI measurement techniques include the development of automated devices and the use of novel sensors, aiming to improve accuracy and ease of use. The Toe-Brachial Index is a valuable non-invasive diagnostic tool for assessing peripheral artery disease, cardiovascular disease, and peripheral neuropathy. Early diagnosis, treatment, and prevention of these conditions can improve patient outcomes and reduce healthcare costs.
References:
1Fowkes, F. G., Rudan, D., Rudan, I., Aboyans, V., Denenberg, J. O., McDermott, M. M., … & Criqui, M. H. (2013). Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. The Lancet, 382(9901), 1329-1340.
2Criqui, M. H., & Aboyans, V. (2015). Epidemiology of peripheral artery disease. Circulation research, 116(9), 1509-1526.
3Rooke, T. W., Hirsch, A. T., Misra , S., Sidawy, A. N., Beckman, J. A., Findeiss, L., … & White, C. J. (2011). 2011 ACCF/AHA focused update of the guideline for the management of patients with peripheral artery disease (updating the 2005 guideline): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 124(18), 2020-2045.
4Callaghan, B. C., Cheng, H. T., Stables, C. L., Smith, A. L., & Feldman, E. L. (2012). Diabetic neuropathy: clinical manifestations and current t reatments. The Lancet Neurology, 11(6), 521-534.
5Boulton, A. J., Armstrong, D. G., Albert, S. F., Frykberg, R. G., Hellman, R., Kirkman, M. S., … & Wukich, D. K. (2008). Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes care, 31(8), 1679-1685.
6Mayfield, J. A., Sugarman, J. R., The, R. P., & White, J. R. (2000). The use of the Semmes-Weinstein monofilament and other threshold tests for preventing foot ulceration and amputation in persons with diabetes. The Journal of Family Practice, 49(11), S17-S29.