A one minute scan of your foot could help prevent amputation – here's how
But as blood flow worsens, a small cut on your foot might not heal. It can turn into an ulcer. In the worst cases, it can lead to amputation. This condition is called peripheral artery disease (PAD) – and it's far more common than many realise.
PAD affects around one in five people over the age of 60 in the UK, and is especially prevalent in people with diabetes, high blood pressure or kidney disease.
PAD is rarely an isolated issue: it's usually a sign of widespread atherosclerosis, the build-up of fatty deposits that can also narrow arteries in the heart and brain.
It also significantly increases the risk of heart attacks, strokes and other conditions linked to poor blood flow to vital organs. Research shows that a large proportion of people diagnosed with PAD will die within five to ten years, most often due to these complications.
Early detection is key to reducing the impact of PAD, and I've been working with colleagues to develop a faster, simpler way to diagnose it.
Doctors can check circulation in the feet by comparing blood pressure in the toe with that in the arm. The result is known as the toe–brachial index (TBI). The trouble is that the test needs a toe-sized cuff, an optical sensor and a doctor who knows how to use the equipment.
Many GP surgeries and foot clinics don't have this kit. And in many people, especially those with diabetes or stiff arteries, the test doesn't always give a clear or reliable, result.
Our research team asked a simple question: could we turn a routine ultrasound scan into a quick, reliable way to measure blood flow in the foot?
Most hospitals, and many community clinics, already have handheld ultrasound probes, which use Doppler sound to track how blood flows through vessels.
This works through the Doppler effect: as blood moves, it changes the pitch of the sound waves. Healthy blood flow creates a strong, steady 'swoosh', while a narrowed or blocked artery produces a faint or disrupted sound. Doctors are trained to hear the difference and use these sound patterns to spot circulation problems, especially in conditions like PAD.
But my research team wondered whether a computer could do more than listen: we wanted to know whether it could convert the shape of that Doppler 'wave' into a number that mirrors the TBI.
To investigate, we scanned the feet of patients already being treated for PAD – 150 feet in all. For each artery, we used Doppler ultrasound to measure how quickly blood surged with each heartbeat, a pattern known as the acceleration index. We then compared these results to the standard toe–brachial index, the traditional test that measures blood pressure in the toe.
The acceleration index alone was able to predict the standard toe–brachial index with 88% accuracy. Using a simple formula, we converted that Doppler reading into an 'estimated TBI' – a number that closely mirrored the conventional result. It needed no toe cuff, no optical sensor and it took under a minute to perform.
Even more encouraging, estimated TBI rose in tandem with traditional TBI results after treatment. When patients underwent angioplasty – a procedure to reopen blocked arteries – their estimated TBI increased almost identically to the measured TBI. That means this scan doesn't just help diagnose PAD; it could also be used to track recovery over time.
Crucially, our approach works with equipment that's already widely available. We repeated the experiment using a basic pocket Doppler: the kind many GPs and podiatrists have tucked in a drawer.
While it wasn't quite as precise as hospital-grade ultrasound, the results were still strong. With some additional software refinement, doctors could soon assess foot circulation quickly and accurately using tools they already own, without adding time to a busy clinic schedule.
Because early diagnosis of PAD changes everything. It can mean the difference between losing a foot, keeping your mobility and living longer with a better quality of life. It can shorten hospital stays and reduce the risk of heart attack and stroke.
But right now, too many people with PAD aren't diagnosed until they already have chronic limb-threatening ischaemia – the most severe form of the disease. This condition occurs when blood flow to the legs or feet becomes critically low, depriving tissues of oxygen. It can cause constant foot pain (especially at night), wounds that won't heal and, in advanced cases, tissue death (gangrene) and the risk of amputation. Without urgent treatment to restore circulation, chronic limb-threatening ischaemia can be life-threatening.
Part of the problem is that the tools used to diagnose PAD are often slow, expensive or too complicated for routine use. That's why a simple, cuff-free Doppler scan that provides a reliable estimate of toe–brachial index is so promising. It uses equipment that many clinics already have, takes less than a minute and delivers immediate results – offering a faster, easier way to spot poor circulation before serious damage is done.
We're now looking at ways to automate the measurement so that it can be used even by non-specialists. We're testing it in various clinics with different patient groups and exploring its performance over time. But the evidence so far suggests that this could become a key part of vascular care – not just in hospitals, but in GP surgeries, diabetes clinics and anywhere else early intervention could save a limb.
Blocked arteries don't need to stay hidden. With the right tools, we can find them earlier, treat them faster and protect people from the devastating consequences of late diagnosis.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Christian Heiss has received funding from Lipton Teas & Infusions, Ageless Science, iThera, the Medical Research Council, the ESRC, European Partnership on Metrology, co-financed from European Union's Horizon Europe Research and Innovation Programme and UK Research and Innovation. He is member of the board of the European Society of Vascular Medicine, president of the Vascular, Lipid and Metabolic Medicine Council of the Royal Society of Medicine, and chairperson-elect of the ESC WG Aorta and Peripheral Vascular Diseases.
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Bangkok Post
2 days ago
- Bangkok Post
Actions speak louder than words
Actions speak louder than words The ruling Pheu Thai Party and the main opposition People's Party (PP) have found themselves idle targets of critics for singing the same tune in the aftermath of the June 28 mass rally in central Bangkok. Both were accused of throwing caution to the wind after suggesting the rally at the Victory Monument -- which sought suspended Prime Minister Paetongtarn Shinawatra's resignation over her leaked phone conversation with Cambodian Senate President Hun Sen -- could spark a military revolt. In what Ms Paetongtarn described as a private conversation, she was heard pleading with Hun Sen to help her out as she was under immense public pressure for appearing to cave in to Cambodia in the intensifying border conflict. The premier came across as being subservient to the Cambodian strongman and went so far as to offer to do what she could in return for Hun Sen's help. The manner and substance of the phone call triggered public uproar, with Ms Paetongtarn being branded by opponents as unpatriotic and a traitor. Collective anger drove tens of thousands to flock to the Victory Monument, one of the city's busiest transit interchanges, in a mass demonstration organised by the so-called United Power of the Land to Protect Sovereignty group on June 28. Rally speakers, several of whom were well-known co-leaders of past mass protests under banners such as the People's Alliance for Democracy (PAD) and the People's Democratic Reform Committee (PDRC), took turns attacking Ms Paetongtarn's ineptitude and inadequacy as premier. The next day, Pheu Thai and PP politicians separately chastised some protest leaders for speaking agreeably about a military coup being staged in the event of political deadlock. Opposition and PP leader Natthaphong Ruengpanyawut expressed concern about the rally, fearing the protests could be used as a pretext for a coup. Mr Natthaphong said he believed the demonstrators were acting in good faith, driven by a desire to see a change of prime minister. He went on to say that there were various legitimate ways to bring about such change, including the prime minister's resignation, impeachment through parliamentary procedures, or the prime minister dissolving the House and calling an election. However, he also noted the risk of change occurring through undemocratic means, such as a coup d'état. "Even if the protesters are acting sincerely, it is concerning that certain protest leaders may exploit the situation to advocate for extra-constitutional measures. "Many of the current protest leaders are familiar faces who have previously opposed elected governments and played roles in past coups," the PP leader said. He pointed out that although no direct call for a coup was made from the protest stage, the speakers also failed to explicitly reject the possibility. The opposition leader is believed to have referred specifically to one speaker, Sondhi Limthongkul, who is a former leader of the now-defunct PAD. "Some rhetoric leaves the door open to the idea -- suggesting that if a coup were to occur, they would simply prefer that the new prime minister not be from the military. That ambiguity raises red flags," he said. However, Mr Natthaphong's comments were immediately shot down by Somchai Srisutthiyakorn, a former election commissioner, in a critical post on his Facebook page "Pun Pai Nai – Somchai Srisutthiyakorn". He warned that while political actors publicly denounce coups, they themselves must also actively engage in democratic processes to resolve national issues, instead of allowing protests to spiral into movements that invite military intervention. "The [June 28] protest ignited like a wildfire," Mr Somchai wrote, "and it's been condemned by both Pheu Thai and the PP as a veiled invitation for a coup, particularly following remarks made by Mr Sondhi on stage." Mr Somchai praised the public's stance against coups, pointing out that the nine years following the last one proved that military intervention failed to take care of the country's issues. However, the former poll commissioner hit out at parties that denounce coups while neglecting to take real action through democratic means. Back in March, the opposition parties filed a no-confidence motion against the premier for dishonesty over tax evasion allegations involving PN (promissory notes) worth more than 200 million baht, allegedly used within her family without a repayment date or interest. Despite losing the no-confidence vote, Mr Somchai noted, the opposition (specifically, the PP) failed to follow up by petitioning the National Anti-Corruption Commission (NACC) or the Constitutional Court to assess Ms Paetongtarn's eligibility to hold office. Also, following the leaked audio clip with Hun Sen -- where she referred to the 2nd Army Region commander in charge of the Thai-Cambodian border as an "opponent" -- Mr Somchai said the proper response would have been for Ms Paetongtarn to resign. Yet, she remained in office, he added. Following Bhumjaithai's withdrawal from the coalition, criticism mounted over Ms Paetongtarn's conduct during the cabinet reshuffle process. Despite this, the coalition parties chose not to withdraw from the government. When Bhumjaithai, which is now in the opposition, attempted to initiate a fresh no-confidence motion, it failed because it did not have the 99 MP signatures required to do so. Mr Somchai faulted the PP for not supporting the motion, citing their excuse that such motions shouldn't be filed too frequently. "If you don't want people to take to the streets and risk inviting a coup, political actors must show true commitment to democratic solutions rather than rely on empty slogans or collusion. "You can't just repeat the same lines about dissolving parliament or do you want people to believe in the existence of the 'Hong Kong Declaration'," Mr Somchai said. The "Hong Kong Declaration" has to do with alleged political deals or secret meetings that supposedly took place in Hong Kong involving former premier Thaksin Shinawatra, who is thought to wield tremendous power in Pheu Thai, and political figures reportedly including Progressive Movement leader Thanathorn Juangroongruangkit, founder of the Future Forward Party, a precursor of the PP. The meetings are believed to have shaped the formation of the current government, according to sources. A battle for survival Former prime minister Thaksin Shinawatra has been making increasingly frequent media appearances, with the most notable being "Unlocking Thailand's Future", hosted by veteran news commentator Veera Teerapat. Veera confronted Thaksin with a question about the "secret deal" widely believed to have enabled him to return to Thailand after 17 years of self-imposed exile. The question appeared to touch a raw nerve, with Thaksin appearing stunned for a moment before replying that there was "no political deal whatsoever with anyone". Thaksin, generally considered the de facto leader of the ruling Pheu Thai Party, returned from self-imposed exile on Aug 22, 2023. That same day, the Supreme Court sentenced him to eight years in prison -- three years in total from two cases and a further five years in a third case. The sentence was later reduced to one year following royal clemency. Thaksin has been actively engaged in politics after his one-year jail term ended. Olarn Thinbangtieo, a political science lecturer at Burapha University, said Thaksin spoke as truthfully as he could in the interview with Veera except over the secret deal, which, according to several observers, will remain a myth. Thaksin's message, despite being cornered by the host, is that a future alliance between Pheu Thai and Bhumjaithai looks increasingly unlikely, even after the next general election, said Mr Olarn. Following Bhumjaithai's exit from the Pheu Thai-led coalition, the political rivalry between the two parties will intensify with both sides trying to present themselves as a strong force to challenge the progressive People's Party (PP). According to Mr Olarn, Thaksin sees himself as indispensable to Thai politics and is signalling that both he and Pheu Thai are better suited to working with the conservative camp than Bhumjaithai. Bhuimjaithai currently faces legal troubles relating to alleged vote-rigging in the Senate polls, and the party could be dissolved if found guilty. For this reason, the conservative bloc had better stick with Pheu Thai as it has already proven it can work without Bhumjaithai, dubbed the "blue" party, according to the analyst. The blue party is under intense pressure as several senior members have been implicated in the Senate election scandal. More than 100 senators are suspected of having ties with Bhumjaithai and are called the blue faction within the Upper House. According to Election Commission (EC) chairman Ittiporn Boonpracong, a subcommittee has completed a probe and submitted its findings to the EC for review, with the EC secretary general to provide opinions to the EC. The review process takes 60 days before it is deliberated by a subcommittee on disputes and arguments, which can take up to 90 days. A final decision by the EC could take as long as nine months. However, Thaksin and his daughter, suspended Prime Minister Paetongtarn Shinawatra, have their own legal troubles to overcome. Thaksin has two cases: one involves his prolonged stay at the Police General Hospital (PGH) until his parole, in what is seen as a ruse to avoid serving prison time, and the other is a lese majeste case for remarks he made during a 2015 interview with South Korean media while in self-imposed exile. The PGH case is under review by the Supreme Court's Criminal Division for Holders of Political Positions, while the lese majeste case is scheduled for a ruling on Aug 22, the second anniversary of his return. Ms Paetongtarn, meanwhile, faces a Constitutional Court decision related to the leaked conversation with Cambodian Senate President Hun Sen, which could determine whether she has violated political ethics. A ruling is expected by mid-August. The fate of both father and daughter will be known by the end of August at the latest, according to observers. Mr Olarn said both Pheu Thai and Bhumjaithai are competing fiercely for the support of the conservative bloc, and they believe they are in a better position to serve conservative interests. Pheu Thai is aggressively pushing for Bhumjaithai's dissolution, hoping to welcome many of its MPs to boost its chances in an election. However, the future looks grim, especially for Ms Paetongtarn, even if she resigns before the Constitutional Court rules on the leaked phone call case. Legal experts believe she still faces the strong possibility of an extended, if not a lifetime, political ban stemming from several criminal complaints currently lodged with the National Anti-Corruption Commission (NACC) and the Criminal Court. These include cases involving illegal land encroachment in Khao Yai, irregularities related to the Alpine golf course, and the questionable use of promissory notes for share transfers. Any of these could result in a five-year to 10-year, or even lifetime ban from politics. Should Thaksin be sent back to prison and Ms Paetongtarn be banned from politics, Pheu Thai could collapse entirely. In such a scenario, many of its MPs could defect to Bhumjaithai since both parties rely on political family networks for support, according to Mr Olarn. "All of this now rests in the hands of the conservative bloc. It depends on which party they choose to trust more -- Pheu Thai or Bhumjaithai," Mr Olarn said.
The Wire
17-07-2025
- The Wire
'NITI Aayog No Substitute,' Says Ex-Bureaucrat as Govt Moves 9 Flagship Schemes Out of Usual Appraisal System
'By doing away with such an appraisal process, and bringing in NITI Aayog, the government is blocking doors to a professional socio-economic appraisal of schemes – something that is essential.' An illustration on the Ayushman Bharat Digital Mission's official site. New Delhi: Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana, and PM Kisan, are among nine of the Narendra Modi government's flagship schemes that the government has decided to keep outside the ambit of the ongoing appraisal process for central sector programmes, Economic Times has reported. Speaking to The Wire, a former secretary in the finance department has called this a move by the government to block doors to a professional socio-economic appraisal of schemes. The report says that in a letter dated July 4, the Department of Expenditure asked the respective ministries and departments to exclude the schemes from the standard appraisal process. This exclusion will remain in place for the next five years, starting April 1, 2026, the report said. These schemes, the letter said, will be evaluated and appraised in detail by the planning think-tank NITI Aayog's Development Monitoring and Evaluation Office. An unnamed senior official quoted by ET noted that this is because some of these schemes will need "some structural changes." "Niti Aayog has been tasked to do the detailed exercise so there is no duplicity of efforts,' the official told ET. The full list of the schemes are: Ayushman Bharat, Pradhan Mantri Jan Arogya Yojana, PM Kisan, Ujjwala Yojana, PM Jan Dhan Yojana, PM Stand Up India, PM Jeevan Jyoti Bima Yojana, PM Suraksha Bima Yojana, and a scheme under the Department for Promotion of Industry and Internal Trade to refund central GST and integrated GST to industrial units in northeastern and Himalayan states. In addition, schemes related to the Department of Space and the Department of Atomic Energy and the National e-Vidhan scheme are also outside the ambit of the appraisal process. A former secretary in the finance department told The Wire that the NITI Aayog is no substitute for an established system of appraisal. The former bureaucrat said that the established practice is that a Public Investment Board (PIB) headed by the expenditure secretary appraises all new schemes that involve large investments. The erstwhile Planning Commission – under the Manmohan Singh-led United Progressive Alliance government – used to have a Project Appraisal Division (PAD) that had expertise in evaluating such schemes and projects. The PAD would give inputs to the PIB for appraisal. The PIB's recommendations on the scheme would then be looked at by the Cabinet for a final decision. The former IAS officer, who headed the PAD and PIB, noted that PAD and PIB inputs added value to schemes. "While recommending a scheme to the Cabinet with improvements, I remember setting apart a small percentage of the investment for independent social audits to provide feedback during implementation," he noted. He also added that NITI Aayog "woefully lacks the required expertise, as PAD used to conduct social-cost social-benefit appraisal, which NITI Aayog is not in a position to do." "By doing away with such an appraisal process, and bringing in NITI Aayog, the government is blocking doors to a professional socio-economic appraisal of schemes – something that is essential," he added. The Wire is now on WhatsApp. Follow our channel for sharp analysis and opinions on the latest developments.
Yahoo
10-07-2025
- Yahoo
A one minute scan of your foot could help prevent amputation – here's how
Imagine having blocked arteries in your legs and not knowing it. At first, there may be no symptoms at all. Just occasional fatigue, cramping or discomfort – symptoms easy to dismiss as ageing or being out of shape. But as blood flow worsens, a small cut on your foot might not heal. It can turn into an ulcer. In the worst cases, it can lead to amputation. This condition is called peripheral artery disease (PAD) – and it's far more common than many realise. PAD affects around one in five people over the age of 60 in the UK, and is especially prevalent in people with diabetes, high blood pressure or kidney disease. PAD is rarely an isolated issue: it's usually a sign of widespread atherosclerosis, the build-up of fatty deposits that can also narrow arteries in the heart and brain. It also significantly increases the risk of heart attacks, strokes and other conditions linked to poor blood flow to vital organs. Research shows that a large proportion of people diagnosed with PAD will die within five to ten years, most often due to these complications. Early detection is key to reducing the impact of PAD, and I've been working with colleagues to develop a faster, simpler way to diagnose it. Doctors can check circulation in the feet by comparing blood pressure in the toe with that in the arm. The result is known as the toe–brachial index (TBI). The trouble is that the test needs a toe-sized cuff, an optical sensor and a doctor who knows how to use the equipment. Many GP surgeries and foot clinics don't have this kit. And in many people, especially those with diabetes or stiff arteries, the test doesn't always give a clear or reliable, result. Our research team asked a simple question: could we turn a routine ultrasound scan into a quick, reliable way to measure blood flow in the foot? Most hospitals, and many community clinics, already have handheld ultrasound probes, which use Doppler sound to track how blood flows through vessels. This works through the Doppler effect: as blood moves, it changes the pitch of the sound waves. Healthy blood flow creates a strong, steady 'swoosh', while a narrowed or blocked artery produces a faint or disrupted sound. Doctors are trained to hear the difference and use these sound patterns to spot circulation problems, especially in conditions like PAD. But my research team wondered whether a computer could do more than listen: we wanted to know whether it could convert the shape of that Doppler 'wave' into a number that mirrors the TBI. To investigate, we scanned the feet of patients already being treated for PAD – 150 feet in all. For each artery, we used Doppler ultrasound to measure how quickly blood surged with each heartbeat, a pattern known as the acceleration index. We then compared these results to the standard toe–brachial index, the traditional test that measures blood pressure in the toe. The acceleration index alone was able to predict the standard toe–brachial index with 88% accuracy. Using a simple formula, we converted that Doppler reading into an 'estimated TBI' – a number that closely mirrored the conventional result. It needed no toe cuff, no optical sensor and it took under a minute to perform. Even more encouraging, estimated TBI rose in tandem with traditional TBI results after treatment. When patients underwent angioplasty – a procedure to reopen blocked arteries – their estimated TBI increased almost identically to the measured TBI. That means this scan doesn't just help diagnose PAD; it could also be used to track recovery over time. Crucially, our approach works with equipment that's already widely available. We repeated the experiment using a basic pocket Doppler: the kind many GPs and podiatrists have tucked in a drawer. While it wasn't quite as precise as hospital-grade ultrasound, the results were still strong. With some additional software refinement, doctors could soon assess foot circulation quickly and accurately using tools they already own, without adding time to a busy clinic schedule. Because early diagnosis of PAD changes everything. It can mean the difference between losing a foot, keeping your mobility and living longer with a better quality of life. It can shorten hospital stays and reduce the risk of heart attack and stroke. But right now, too many people with PAD aren't diagnosed until they already have chronic limb-threatening ischaemia – the most severe form of the disease. This condition occurs when blood flow to the legs or feet becomes critically low, depriving tissues of oxygen. It can cause constant foot pain (especially at night), wounds that won't heal and, in advanced cases, tissue death (gangrene) and the risk of amputation. Without urgent treatment to restore circulation, chronic limb-threatening ischaemia can be life-threatening. Part of the problem is that the tools used to diagnose PAD are often slow, expensive or too complicated for routine use. That's why a simple, cuff-free Doppler scan that provides a reliable estimate of toe–brachial index is so promising. It uses equipment that many clinics already have, takes less than a minute and delivers immediate results – offering a faster, easier way to spot poor circulation before serious damage is done. We're now looking at ways to automate the measurement so that it can be used even by non-specialists. We're testing it in various clinics with different patient groups and exploring its performance over time. But the evidence so far suggests that this could become a key part of vascular care – not just in hospitals, but in GP surgeries, diabetes clinics and anywhere else early intervention could save a limb. Blocked arteries don't need to stay hidden. With the right tools, we can find them earlier, treat them faster and protect people from the devastating consequences of late diagnosis. This article is republished from The Conversation under a Creative Commons license. Read the original article. Christian Heiss has received funding from Lipton Teas & Infusions, Ageless Science, iThera, the Medical Research Council, the ESRC, European Partnership on Metrology, co-financed from European Union's Horizon Europe Research and Innovation Programme and UK Research and Innovation. He is member of the board of the European Society of Vascular Medicine, president of the Vascular, Lipid and Metabolic Medicine Council of the Royal Society of Medicine, and chairperson-elect of the ESC WG Aorta and Peripheral Vascular Diseases.
