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Stefan A. Carter, MD
St Boniface General Hospital Winnipeg, Manitoba

JAMA. 1982;247(17):2370.

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In Reply.—

Dr LeMaitre's letter is of value in drawing the attention of the profession to the use of walking and postexercise measurements of the ankle pressures in the assessment of patients with leg pain, which may or may not be due to arterial obstruction. Most physicians would agree with his general approach and the statement that one should not submit a patient to angiography, nor carry out surgery unless the claudication is disabling.

Certain points are worth considering in relation to his protocol.

1. The use of walking and measurement of ankle pressures has been well documented1 and is of particular value in the differential diagnosis of pseudoclaudication, which may be due to spinal or musculoskeletal disorders, and in patients in whom arterial obstruction may coexist. In the latter cases careful history is of paramount importance.
   

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