Podiatry Ankle Duplex Scan: Readily Learned and Accurate in Diabetes

Abstract

We aimed to train podiatrists to perform a focused duplex ultrasound scan (DUS) of the tibial vessels at the ankle in diabetic patients; podiatry ankle (PodAnk) duplex scan. Thirteen podiatrists underwent an intensive 3-hour long simulation training session. Participants were then assessed performing bilateral PodAnk duplex scans of 3 diabetic patients with peripheral arterial disease. Participants were assessed using the duplex ultrasound objective structured assessment of technical skills (DUOSATS) tool and an "Imaging Score". A total of 156 vessel assessments were performed. All patients had abnormal waveforms with a loss of triphasic flow. Loss of triphasic flow was accurately detected in 145 (92.9%) vessels; the correct waveform was identified in 139 (89.1%) cases. Participants achieved excellent DUOSATS scores (median 24 [interquartile range: 23-25], max attainable score of 26) as well as "Imaging Scores" (8 [8-8], max attainable score of 8) indicating proficiency in technical skills. The mean time taken for each bilateral ankle assessment was 20.4 minutes (standard deviation ±6.7). We have demonstrated that a focused DUS for the purpose of vascular assessment of the diabetic foot is readily learned using intensive simulation training.

Clinical examination and non‐invasive screening tests in the diagnosis of peripheral artery disease in people with diabetes‐related foot ulceration

“…Waveform analysis was the best screening tool to exclude peripheral artery disease in our study and Normahani and colleagues [30] demonstrate that it is possible to train podiatrists to perform a focused duplex ultrasound scan of the tibial vessels at the ankle. The costs of training and the availability of ultrasound machines may be limitations.…”

Diagnostic Accuracy of Point-of-care Tests Used to Detect Arterial Disease in Diabetes

“…We have previously demonstrated that a focused DUS scan of the anterior and posterior tibial arteries at the ankle (PAD-scan; Podiatry Ankle Duplex scan; Figure S1-2, http://links.lww.com/SLA/C885) can be readily learnt and accurately performed by frontline staff. 10,11…”

“…We have previously demonstrated that a focused DUS scan of the anterior and posterior tibial arteries at the ankle (PAD-scan; Podiatry Ankle Duplex scan; Figure S1-2, http://links.lww.com/SLA/ C885) can be readily learnt and accurately performed by frontline staff. 10,11 The primary aim of this present study is to determine the ability of the PAD-scan and other commonly performed index tests [handheld Doppler (audible and visual), ABPI, TBPI, TcPO2, and pulse palpation] to discriminate between the presence and absence of PAD in diabetes, as compared with the reference test of full lower limb arterial DUS.…”

Effectiveness of a multicenter training programme to teach point‐of‐care vascular ultrasound for the detection of peripheral arterial disease in people with diabetes

“…The training programme was divided into four phases over 8 weeks. The design of the programme was informed by the feedback received from our previous departmental experience of running ultrasound courses for novices [9]. All scans performed in this study utilised the Mindray M7 (Shenzhen, China) Portable Ultrasound System with a linear 6–14 kHz transducer.…”

“…But, in order for the scan to be feasible and immediately useful in clinical practice, it must be rapidly learned, fast and accurately performed by front line healthcare workers, such as podiatrists. Our group has previously demonstrated that podiatrists with no previous ultrasound experience can be taught to perform the scan on patients with 3‐h of intensive training [9]. However, for clinical evaluation a more rigorous approach to training is required.…”