ABI with Toe Exam

ABI with Toe Exam | Newman Medical
Essential for Diabetic Patients

ABI with Toe Exam

The Toe-Brachial Index (TBI) extends ABI testing to capture small vessel disease — critical when ankle arteries are calcified and standard ABI readings are unreliable.

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Sample ABI with Toe Exam Report Sample Report

When Standard ABI Is Not Enough

In diabetic and elderly patients, ankle arteries frequently calcify and become non-compressible. When ankle pressures exceed 200 mmHg or the ABI exceeds 1.40, the reading is considered non-diagnostic — and PAD may still be present.

The Toe-Brachial Index solves this. Digital arteries in the toes are rarely affected by calcification, making TBI the preferred method for detecting PAD in patients where standard ABI fails. A TBI below 0.70 is diagnostic for PAD.

How It Works

The ABI with Toe exam is typically performed following a standard ABI — either to confirm a borderline result or whenever ankle calcification is suspected.

1

Complete Standard ABI

Arm and ankle pressures captured first. If ankle pressure exceeds 200 mmHg or ABI exceeds 1.40, TBI is indicated.

2

Apply Digit Cuffs + PPG Probe

Small digit cuffs placed on both great toes. The PPG photoplethysmography probe captures toe arterial pulses.

3

TBI Calculated & Reported

Software calculates toe-brachial ratio and generates a combined ABI + TBI report with waveforms and interpretation.

When to Order This Exam

✔

Ankle ABI result is non-diagnostic (>1.40 or >200 mmHg)

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Diabetic patients — annual vascular screening

✔

Suspected small vessel or distal arterial disease

✔

Pre-amputation assessment or wound care planning

✔

Patients with chronic kidney disease (CKD)

✔

Any patient where calcification is likely

Reimbursable CPT Codes:
9392293923

Available On

TBI capability requires a system equipped with PPG probe support and digit cuffs.

ABI-300

Manual ABI + TBI

ABI-400CL

Automated single-level

ABI-450CL

Single-level + exercise

ABI-500CL

Automated multi-level

ABI-600CL

Multi-level + exercise

Documents

Training Videos

Questions About This Exam?

Schedule a 30-minute consultation. We'll walk through the protocol, the report output, and which system fits your workflow.

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Background

The ABI with Toe exam is typically performed after an ABI has been done, especially if the larger ankle arteries appear to be incompressible (pressure over 200mmHg) or anytime more information is needed about small vessel disease. The ABI with Toe is performed using the PPG probe on the toes. The patient is supine and rested in a warm room.

Helpful Documents

Training Videos

Available on the following systems: