OnExam

This test is used when arterial insufficiency is suspected in the legs.

Performing the Test

  1. While patient is supine, raise both of the patient's legs to approximately 60° until pallor of the feet develops. This usually takes about a minute. Maintenance of normal colour is also normal at this stage.
  2. Ask patient to sit up, allowing his/her legs to dangle off the table. Observe and compare both feet, noting:
    • The time required for normal pinkness to return to the skin (usually about 10 seconds).
    • The time required for the veins of the feet and ankles to fill (usually about 15 seconds).
  3. Look for:
    • Persistent pallor. This indicates arterial insufficiency.
    • Unusually pronounced rubor (darker than the patient’s normal skin tone). This may take more than a minute to appear. This also indicates arterial insufficiency.
    • Normal colour responses which occur simultaneously with diminished arterial pulses may suggest that, despite occlusion, adequate collateral flow has developed.

Special Notes

  • Colour changes may be difficult to characterize in darker skinned patients. Inspection of the sole of the foot and use of tangential lighting to observe colour and venous filling may be useful.
  • This test is not reliable if venous valves are incompetent. Return of colour and venous pattern may be due to retrograde blood-flow in this case.
  • For venous filling time greater than 20 seconds, sensitivity and specificity for peripheral vascular disease were found to be 22% and 94%, respectively.

References

  1. Insall, RL, Davies RJ, Prout WG. Significance of Buerger’s test in the assessment of lower limb ischaemia. J R Soc Med. 1989; 82:729-731