Diabetic patients referred for duplex scanning of the lower extremity arteries were included if they had foot lesions such as ulcers, gangrene, or tissue necrosis and had no palpable pedal pulses.

On examination, the patient had a full complement of lower-limb pulses. A lower-limb arterial duplex scan detected bilateral popliteal artery occlusion on forced plantar flexion. As there were ...