Placement of the healthy foot in the dependent position below heart level decreases capillary blood flow, and elevation produces no changes in flow.
4 However, the same maneuver in patients with foot pain at rest and clinically significant atherosclerosis results in increased capillary blood flow with pedal dependency (ie, the patient is seated on an examination table with the foot in the down position) and decreased capillary blood flow on pedal elevation.
4 The Buerger test should be used to evaluate patients suspected of having reduced circulation due to vascular obturation.
1 When administering this test, physicians should elevate the limb to be perpendicular to the horizontal plane, which would cause pallor in patients with clinically significant peripheral vascular disease.
1 On gradual lowering of the limb, the angle at which the color returns (ie,
the angle of circulatory sufficiency) should be recorded.
1 In a variation of the Buerger test, the affected limb should be elevated to 60º from the horizontal plane for 2 minutes, and then the limb should be placed in the dependent position for another 2 minutes.
5 Limb pallor during this test indicates peripheral artery disease, as does rubor in the dependent position. Although Buerger noted that the angle of the leg that results in pallor is a valuable adjunct in the recognition of the extent of circulatory disturbance and prognosis, no studies have been published, to the authors’ knowledge, that correlate specific angles to the degree of arterial occlusion.