Why circulation is checked before compression

Compression wraps and stockings squeeze the leg to help veins push blood and fluid back toward the heart. Arteries carry blood the other way, down to the foot. If the arteries are narrowed, a firm squeeze can reduce flow that is already low and injure the skin. An ankle brachial index test before compression is the usual way a clinician confirms the arteries can tolerate it.

Narrowed leg arteries, called peripheral artery disease, often cause no symptoms. Leg ulcers can be venous, arterial or mixed, and they can look alike.

What an ankle brachial index is

The ankle brachial index, or ABI, compares the blood pressure at your ankle with the blood pressure in your arm. In healthy arteries the two are about the same. When leg arteries are narrowed, the ankle pressure drops.

What to expect:

  1. You lie flat and rest for several minutes.
  2. Blood pressure cuffs are placed on your arms and just above your ankles.
  3. The clinician puts gel on the skin and listens to the pulse with a handheld Doppler probe while each cuff is briefly inflated and released.
  4. The ankle pressure is divided by the arm pressure to give a number for each leg.

There are no needles, and each cuff squeezes only briefly.

What the number means in general

Your clinician reads the result alongside the exam. Commonly used reference points:

  • About 1.0 to 1.4: ankle and arm pressures are similar, which is the expected finding
  • 0.9 or lower: suggests narrowed arteries, and the lower the number, the less blood is getting through
  • Above 1.4: the arteries may be too stiff for the cuff to compress, so the result cannot be trusted

Stiff, calcified arteries are common with diabetes, kidney disease and advanced age. When that happens, another test is needed.

Related circulation tests

  • Toe pressures or toe brachial index. A small cuff on the big toe. Toe arteries stiffen less, so this is often used for people with diabetes.
  • Doppler waveforms. The sound and shape of the pulse signal, which show the quality of flow.
  • Arterial duplex ultrasound. Pictures of the arteries with flow measurements, showing where a narrowing sits.
  • Venous duplex ultrasound. Looks at the veins instead, for leaking valves or a clot.

Feeling for pulses by hand is part of a good exam, but it is not usually enough on its own to clear someone for firm compression. When a test is done elsewhere, Gateway can help with lab and imaging coordination.

How results shape the compression plan

The treating clinician decides. In general, good arterial flow supports compression at the strength ordered. Reduced flow may lead to lighter or modified compression with closer checks. Severely reduced flow usually means compression is held and a vascular referral comes first, because restoring blood flow may be what an arterial or mixed wound needs most.

Questions to ask and things to mention

  • Has the circulation in my legs been tested, when, and what was the result for each leg?
  • Is an ABI reliable for me, or do I need toe pressures?
  • What strength of compression was ordered, and why?

Mention leg pain when walking that eases with rest, foot pain at night that improves when you hang the leg down, a past stent or bypass, past blood clots, and whether you smoke.

What to report once you are in compression

Report these promptly, and ask in advance whether to remove the wrap if they happen:

  • New or worse pain in the foot or toes
  • Toes that turn pale, blue, cold or numb
  • A wrap that has slid into a tight band

Call 911 if a foot or leg suddenly becomes cold, pale and very painful, or you cannot move it. Gateway is not an emergency service.

How Gateway coordinates circulation testing

Gateway arranges compression therapy visits with partner clinicians in Greater St. Louis and the Metro East. We request earlier test results, schedule the testing the clinician orders, send records to a vascular specialist and keep the clinician who follows your circulation and vascular health informed.

Call 314-325-0126 or request care online with a name and phone number.

Common questions

Does a normal ABI mean my leg wound is not a circulation problem?

Not quite. A normal result makes significant artery disease less likely and tells the clinician that compression is probably safe. It does not explain the wound by itself. Vein problems, swelling, pressure and diabetes still have to be sorted out, and a normal reading can be falsely reassuring when arteries are stiff. Ask what the treating clinician believes is driving your wound.

Can the test be done if I have a wound on my ankle?

Usually, yes. The wound is typically covered with a protective layer first, and the cuff may be placed a little higher or a toe pressure used instead. If the area is too painful, the clinician may choose an ultrasound study that does not need a cuff over the wound. Ask for a pause if the squeeze becomes too painful.

Why did my clinician say my ABI result was unreliable?

The test assumes the cuff can briefly squeeze the artery shut. When artery walls are hardened with calcium, the cuff cannot compress them and the number reads falsely high, even if flow is poor. A result like that cannot rule artery disease in or out. Toe pressures, waveforms or an ultrasound are the usual next step.

I have worn compression stockings for years. Why test my circulation now?

Arteries change over time, particularly with age, diabetes, smoking or kidney disease, so a leg that tolerated compression years ago may not tolerate it today. A new wound, new foot pain, a wound that has stopped improving or a plan for stronger compression are all reasons to check again. Ask when your arteries were last measured and when the test should be repeated.

Related pages

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.

Updated October 2026