Toe pressure is typically used when ankle pressure is falsely elevated. What toe-brachial index value is considered abnormal?

• A. 0.60–0.70
• B. 0.80–0.90
• C. Less than 0.60
• D. Greater than 1.0

Answer: (C)

Toe-brachial index measures distal perfusion by comparing the toe systolic pressure to the brachial systolic pressure. It’s especially helpful when ankle pressures are unreliable from arterial calcification because the toe arteries are less affected by medial calcinosis, so the toe reading better reflects true limb perfusion.

Normal toe-brachial index values are generally around 0.7–0.9 (often considered acceptable perfusion). Values in the 0.60–0.70 range are sometimes labeled borderline, but an index below 0.60 indicates significant distal arterial disease and impaired perfusion. Therefore, an abnormal toe-brachial index is a value less than 0.60, which signals substantial ischemia and higher risk for nonhealing wounds or limb loss. Values above 1.0 are not physiologically expected and typically reflect measurement error or technique issues.