Measurement of toe systolic pressures: a technique paper

Background: Toe systolic pressures (TSP) are an essential part of a lower limb wound assessment. They assist wound clinicians ascribe aetiology, and predict wound healing capacity, assisting with triage and ongoing care planning.

TSP Method: The toe cuff should be placed around the base of the hallux securely. The photoplethysmography (PPG) probe should be placed on the distal pulp of the hallux so that the probe is flush with the skin surface, affixed with tape. Wait for a strong cyclical signal from the probe to appear on the Doppler screen. Next, inflate the cuff, taking care not to overinflate. Once a flat line with the PPG signal is obtained on the screen, inflate a further 20mmHg. Then, slowly deflate the cuff at a rate of 2-5mmHg per second. The first regular cyclical waveform on the screen is the point at which the pressure in the artery is greater than the pressure in the cuff, and is considered the TSP.

Discussion: TSP are a valuable measure to include in wound practice. TSP are an important part of wound staging systems, can predict wound healing capacity and help guide ongoing management.