Lower limb vascular assessment techniques used by Maltese podiatrists

Abstract

Background: Peripheral arterial disease (PAD) refers to atherosclerosis that may occlude blood vessels distal to the aorta, particularly in the lower limbs. Podiatrists play a crucial role in early identification of PAD in both symptomatic and asymptomatic patients by using non-invasive vascular assessment methods. However, the current podiatric vascular practices in Malta are not known. Aim: To investigate current methods of lower limb vascular assessment carried out in routine clinics by Maltese podiatrists, and to assess whether any barriers or practitioner characteristics influence the effective application of vascular assessment techniques. Design & Methods: A quantitative, descriptive, cross-sectional design was applied to reach the aims and objectives of this study. All participants received a web-based, secure, anonymous, self-administered questionnaire to obtain information regarding the participant’s demographics, vascular assessment techniques, podiatrists’ interpretation of results and diagnostic cut-off points indicative of PAD, clinical indicators prompting vascular assessment, main clinical barriers, and topics discussed during patient education. Results: Thirty participants accessed the online questionnaire and after exclusions, 29 responses were included for analysis. Practitioner characteristics such as education level, years of experience and practice setting, did not influence vascular assessment practices among Maltese podiatrists as the vast majority use the hand-held Doppler. Interpretations of objective tests were variable, and more than half of the participants do not use or are not comfortable with interpreting ABPI and TBPI readings (62.1% and 72.4% respectively). The most common indicators for vascular assessment were diabetes (96.4%), symptoms of claudication (89.3%) and new patient assessment (85.7%). On the other hand, 10.7%, 7.1%, 46.4% and 35.7% of participants associate cardiovascular risk factors, such as hypertension, dyslipidaemia, active smoking, and a history of cardiovascular disease respectively, with the need to assess for PAD. The most common clinical barriers were time constraints (37.9%) and lack of equipment (41.4%), while 48.3% stated that there were no barriers. Conclusion: Podiatrists working in both private and public sector most frequently use hand-held doppler only for vascular assessment in routine clinics. Time constraints and lack of equipment were the most common clinical barriers which hinder the use of objective testing methods. This study has highlighted that there is a lack of knowledge among Maltese podiatrists related to the application of objective measures and their cut-off points to diagnose PAD. The need for further post-graduate training is elicited as it may potentially improve knowledge among Maltese podiatrists to allow for better management of patients with PAD.