Høyer C, et al. - In this investigation, researchers described individuals with low toe-brachial index (TBI) but normal ankle-brachial index (ABI), and chart potential underestimation of peripheral arterial disease (PAD) prevalence by solitary use of ABI. They compared a total of 3,739 consecutive patients with known or suspected PAD referred for ABI and TBI measurements in a four-year period to an age- and gender matched control group (n = 17,340). Data reported that 65.0% had low ABI, 20.5% had low TBI but normal ABI, and 14.5% had normal indices in the patient cohort. Moreover, low TBI but normal ABI patients showed comparable comorbid characteristics to low ABI patients, who have a well-described increased cardiovascular morbidity and mortality risk. ABI's solitary use underestimated the prevalence of PAD in the population, and the routine use of TBI could potentially improve PAD screening.