RAPID RESPONSES FROM BMJ.COM

doi:10.1136/bmjusa.02010003

BMJ, doi: 10.1136/bmjusa.02010003, (Published 4 September 2002)

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RAPID RESPONSES FROM BMJ.COM

Proximal and distal arteries must be investigated in compression-associated forefoot ulceration

The first 150 words of the full text of this article appear below.

This article originally appeared in BMJ USA

EDITOR $---$ We wish to comment on the description by Chan et al of toe and cleft ulceration of unknown cause in patients undergoingcompression bandaging for venousulcers.

Isolated chronic venous insufficiency and peripheral arterial occlusive disease commonly occur in ageing western populationsand may coexist in the aetiology of leg ulcer disease. Ulcersof overt mixed arterial/venous aetiology account for more than10% of ulcerated limbs.¹ Pulse palpation and resting anklepressure measurements are routinely used to screen for moderate-to-severearterial disease in leg ulcer aetiology. These tests cannot beused to exclude mild-to-moderate arterial disease. Exercise stresstesting can reveal lesions that may not have appeared significantat rest, but post-exercise ankle pressure measurement is oftenimpractical in this group of patients.²

Foot ischemia may arise from occlusive disease affecting arteries proximal to the ankle and/or in foot vessels.³ Subclinical. . . [Full text of this article]