Leg pain when walking
A classic symptom is intermittent claudication: pain, cramping, heaviness or muscle fatigue that appears when walking, often affects the calf (sometimes the thigh or buttock) and improves with rest.
Diagnostic tests · Saint‑HyacintheLeg circulation
Ankle-brachial index (ABI): assessing arterial circulation in the legs
A simple, non-invasive test to assess blood circulation in the lower limbs.
The ankle-brachial index, often called the ABI, compares the blood pressure measured at the ankles with the blood pressure measured at the arms.2 This comparison produces an index that helps determine whether blood is flowing normally in the arteries of the legs.
The ABI is used, among other things, to assess peripheral artery disease, a condition in which the arteries of the lower limbs may be narrowed or blocked.
The test
What is the ankle-brachial index?
Systolic blood pressure is measured at the arms, then at the ankles, and the values are compared to calculate a ratio.
In general, the pressure measured at the ankle should be similar to or slightly higher than the pressure at the arm. When it is clearly lower, this may indicate that circulation to the lower limbs is reduced.
In simple terms:
ABI = systolic pressure at the anklesystolic pressure at the arm
Interpretation is always done in the context of the person’s clinical situation.
The calculation uses the higher of the systolic pressures measured in both arms: that is why both arms are measured.3
Why it matters
Peripheral artery disease doesn’t only affect the legs
Over time, atherosclerotic plaques can narrow certain arteries. When this affects the arteries of the legs, it is called peripheral artery disease (PAD).
This reduced blood flow can go unnoticed or cause symptoms, especially when walking or during exertion. Narrowing of the leg arteries is also associated with an increased risk of heart attack and stroke.2
- Pain when walking
- Leg circulation
- Overall cardiovascular risk
Indications
In what situations may an ABI be ordered?
Abnormally cold feet or legs
A persistent difference in temperature between limbs or an unusual feeling of cold may justify a circulation assessment. However, these symptoms are not specific.
Slow-healing wound
Poor circulation can slow the healing of a wound on the foot or leg. A vascular examination helps determine whether arterial circulation is contributing to the problem.
Weak pulses in the feet
During the physical examination, some pulses in the lower limbs may be weak or difficult to feel. The ABI can then complement the assessment.
Cardiovascular risk factors
Current or past smoking, diabetes, hypertension, high cholesterol or atherosclerosis elsewhere in the body increase the risk.2 Whether an ABI is appropriate depends on the overall situation.
Diabetes
Diabetes is an important risk factor. It can also be associated with calcification of the leg arteries, which calls for careful interpretation of the ABI.2
Your appointment
How is an ABI done?
Positioning
You are positioned lying down.2 The test is non-invasive: no needles or injections.
Cuffs
Blood pressure cuffs are placed on the arms and ankles.2
Measurements
At the clinic, the MESI device measures blood pressure on three limbs simultaneously, automatically, in about one minute.4
Calculation
The values are used to calculate the index for each leg, while checking the quality of the measurements.
Interpretation
How is an ABI result interpreted?
The resting ABI is generally classified as follows.1
1,00 à 1,40
Normal
The pressure measured at the ankle is comparable to that of the arm.
0,91 à 0,99
Borderline
Depending on symptoms and context, further investigation may be considered.
0.90 or less
Abnormal
Consistent with peripheral artery disease in the appropriate clinical context.
Greater than 1.40
Possibly non-compressible arteries
A high value does not mean that circulation is better. Another test, such as the toe-brachial index, may be needed.
Why can a very high result be a problem?
Some people have significant calcification of the artery walls, seen more often in some people living with diabetes or chronic kidney disease.
The arteries become difficult to compress with the cuff: the measured pressure may appear artificially high and the ABI becomes less reliable. When the arteries are calcified, an ABI greater than 1.4 cannot reliably diagnose peripheral artery disease.3
Does a normal ABI completely rule out arterial disease?
No.
A person may have suggestive symptoms despite a normal or borderline resting ABI. Depending on the situation, other tests may be considered:
- a post-exercise ABI;
- a toe-brachial index;
- segmental pressure measurements;
- Doppler waveform analysis;
- a vascular Doppler ultrasound;
- or other vascular imaging.
Good to know
Is the ABI painful?
The test is generally well tolerated. As with a blood pressure measurement, the cuff inflates and may cause a tight feeling for a few seconds.
No needles or injections are needed.
Do I need to prepare?
Usually, no complicated preparation is needed.
- wear clothing that allows easy access to your arms and ankles;
- tell the health professional about your vascular history;
- mention any recent procedure on your limbs.
Cleveland Clinic also suggests avoiding caffeine, tobacco, alcohol and exercise in the hour before the test.3
ABI or Doppler ultrasound?
The ABI compares the pressures in the arms and ankles: it quickly gives an overall indication of circulation to the legs.
A Doppler ultrasound looks more directly at the blood in the arteries and helps pinpoint the location or severity of a narrowing.
After the result
Why detect peripheral artery disease?
It is a manifestation of atherosclerosis and may signal a broader cardiovascular risk.
The goal is both to protect circulation in the legs and to reduce overall cardiovascular risk.
The health professional may assess, among other things:
- blood pressure;
- cholesterol;
- diabetes;
- smoking;
- physical activity;
- medications;
- and other cardiovascular risk factors.
When should I seek care quickly?
Sudden, severe pain in one leg, accompanied, for example, by:
- a very cold foot;
- a marked change in colour;
- a loss of sensation;
- sudden weakness;
- or an absent pulse,
may be a vascular emergency.
In such a situation, a scheduled ABI must not delay an urgent medical assessment.
Ankle-brachial index in Saint-Hyacinthe
At Clinique IPS du Palais, we perform the ankle-brachial index on site when the clinical situation warrants it.
Having the test done at the clinic allows the results to be integrated into your follow-up and, if needed, to guide the next steps of the investigation.
Ankle-brachial index$90
Frequently asked questions
Frequently asked questions about the ABI
Does the ABI require a blood test?
No. It is an external test performed using blood pressure measurements.
Do you need to fast?
Usually not.
Can I walk after the test?
Yes. A resting ABI usually does not require any particular restrictions after it is performed.
Does a low ABI mean that I have a completely blocked artery?
Not necessarily. A low ABI indicates reduced blood pressure to the affected limb and may be consistent with peripheral artery disease. On its own, it cannot determine which artery is affected or the exact degree of each narrowing.
Can you have peripheral artery disease without pain?
Yes. Some people with the disease have no symptoms or have atypical symptoms.
Does the ABI replace a medical consultation?
No. The ABI is an additional clinical data point. The result must be interpreted along with symptoms, medical history, the physical examination and cardiovascular risk factors.
Key takeaways
The ankle-brachial index is a simple, non-invasive test that compares the blood pressure in the ankles with that in the arms. It can help assess leg circulation, detect peripheral artery disease, complete the assessment of pain when walking and better assess overall cardiovascular risk.
An abnormal result should not be interpreted on its own and may require further investigation or follow-up.
Sources
- CIUSSS de la Capitale-Nationale. Dépistage des maladies artérielles périphériques (clinical tool CN00152). August 24, 2023, accessed October 5, 2026. ciusss-capitalenationale.gouv.qc.ca
- Mayo Clinic Staff. Ankle-brachial index. Mayo Clinic, accessed October 5, 2026. mayoclinic.org
- Cleveland Clinic. Ankle-Brachial Index (ABI). Accessed October 5, 2026. clevelandclinic.org
- MESI. Ankle-brachial index — MESI mTABLET ABI. Modified September 28, 2026, accessed October 5, 2026. mesimedical.com
The information on this page is provided for informational purposes and does not replace an assessment by a health professional.