Vascular evaluation of the problem diabetic foot.

Ischemia plays a pivotal role in the management of the problem diabetic foot. Prompt revascularization offers the patient with diabetes with lower-extremity ischemia the best hope for limb salvage and normal ambulation. The true vascular status of the diabetic foot may be difficult to assess by clinical examination. Because of the dangers of missing correctable vascular disease, noninvasive vascular testing plays an important role in the evaluation of the problem diabetic foot. The laboratory should have documented reliability, and its results must be interpreted in the context of the patient's clinical progress. The most common laboratory error is overestimating the blood supply to the foot because of technical problems with mural calcification. Algorithms for the use of the vascular laboratory for common foot problems are presented. The vascular laboratory, although helpful, is no substitute for clinical judgement. When ischemia is suspected or when response to conservative care is poor, early vascular surgical consultation is prudent.