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Orthodontics – Correction of irregular teeth: Treatments

Anyone with maligned and irregular teeth, buck teeth, crowded teeth, overlapping teeth or ones with with gap in between may require orthodontic treatment.

Why is Orthodontic treatment Improtant?

Orthodontic treatment can improve your dental health and change your facial appearance for the better, and it can boost your self esteem. Crowded teeth are difficult to clean and may contribute to tooth decay and gum diseases.

When should the treatment begin?

There is no single answer for this question because each orthodontic problem determines its own best starting time. For this reason it is recommended that every child first visit an orthodontist at the age of seven years. In many patients early treatment achieves better results that are unattainable once the face and jaws have finished growing. Another plus point is that early intervention frequently makes the completion of treatments at a later age easier and less time consuming.

What about adult treatment?

Orthodontic treatment can be successful at any age. The health of an individual’s gums and supporting bone is what’s most important in determining the prospects of improving an adult’s smile. Because an adult’s facial bones are no longer growing, certain corrections cannot be accomplished with braces alone and may require surgical intervention.

What does treatment involve?

This is commonly done by fixing braces to teeth and straightening them out. In some cases a patient may need to get some teeth removed in order to fix the braces. However, if the patient is seen at a young age and if the problem is not severe then entire treatment may be carried out without removal. It is critical therefore to visit an orthodontist at the earliest sign of irregular teeth.

Is the treatment very painful?

The treatment is certainly not painless, but the pain is mild and lasts for 2-3 days after initial visit to orthodontist. Recent advances in orthodontics have made treatment far more comfortable.

Does this treatment affect my performance at school/ work/ sports?

Not at all. You will only need to take reasonable care of your braces during contact sports like boxing, football, hockey, cricket etc . to prevent damage to the braces and injury to the teeth and lips. Treatment timeActive treatment with orthodontic appliance ranges from one to two years. The actual time depends on the growth, the co-operation of the patient and the severity of problem.

Lingual Orthodontics

Lingual orthodontics technique involves use of very small braces from behind the teeth,making them perfectly invisible!The best part is that the patients can appreciate the corrections of their tooth alignment as and when they happen.We use the S.T.B. line of lingual brackets, which are, arguably, the most advanced and smallest brackets in the world. Due to small size, speech is not at all disturbed and comfort is even more than with the conventional braces. Dr.Gandhi is specially trained to treat patients with this latest technique. Apart from lingual orthodontics, we also offer CLEAR ALIGNERS to treat moderate irregularities without using any wires or braces!

Diabetic Neuropathy: Treatments

Foot infections are a serious complication of diabetes associated with substantial morbidity and occasional mortality. Antibiotic therapy for mild infections in patients who have not recently received antibiotic therapy can often be directed at just staphylococci and streptococci. Empiric therapy for infections that are chronic, moderate or severe, or that occur in patients who have failed previous antibiotic treatment, should usually be more broad spectrum. Bone infection also complicates a substantial percentage of diabetic foot wounds and increases the likelihood of treatment failure, requiring lower extremity amputation. An increasing body of evidence supports the effectiveness of nonsurgical treatment of diabetic foot osteomyelitis in selected patients, although the optimal choice of agent, route of administration and duration of therapy have yet to be defined. This article examines the potential role of standard and newer antibiotics that may be appropriate for treating diabetic foot infections, including ertapenem, vancomycin, moxifloxacin, daptomycin, telavancin and tigecycline, as well as several investigational agents, such as dalbavancin, ceftobiprole and nemonoxacin.

People with diabetes are at high risk for developing infections of the foot. It is estimated that in the USA, 15% of diabetic patients will develop a foot ulcer in their lifetime[1] and diabetics have at least a tenfold greater risk of hospitalization for foot infections compared with individuals without diabetes.[2] More than 60% of non-traumatic lower-limb amputations occur in people with diabetes, the majority of which are preceded by an infected foot wound.[3–5] The likelihood of adverse outcomes is even higher in developing countries where access to medical care, especially advanced treatment modalities, is often limited. Morbidity and mortality associated with diabetic foot infections (DFIs) can be expected to increase in light of the fact that the number of people with diabetes worldwide is projected to double, reaching approximately 366 million by 2030.[6]

Diabetic foot infections result from a complex interplay among three main complications of long-term diabetes: immunopathy, neuropathy and arterial disease. In vitro evidence suggests that in the diabetic patient neutrophil function is compromised, with impaired chemotaxis and phagocytosis.[7–9] Diabetic neuropathy leads to foot deformity, which results in high pressure areas, leading to calluses and eventually breaks in the protective skin envelope. Sensory neuropathy leads to a decreased awareness on the part of the patient of potential risks to the foot, or failure to recognize that a foot wound, especially if infected, requires urgent treatment. Peripheral arterial disease jeopardizes the viability of soft tissue and bone, and facilitates the spread of infection by compromising the penetration of leukocytes and antibiotics to the infected site.

Bacteria most commonly gain entry to subcutaneous tissues by a disruption of the normal cutaneous barrier. This may occur through small fissures between the toes, acute traumatic wounds, burns or chronic pressure-related ulcers. Infection may remain mild and localized, or spread rapidly along tendon sheaths and fascial planes. An infection that begins under a metatarsal head, for example, may quickly progress to an abscess in the plantar space, which requires urgent surgical intervention.

Properly treating DFIs requires knowledge in several fields and often special surgical skills. Thus, a multidisciplinary approach, including specialists in infectious diseases, foot surgeons (orthopedic or podiatric), endocrinologists, vascular surgeons and wound care experts, can optimize treatment outcomes. Assembling such a team, ensuring that it follows evidence-based guidelines and regularly audits its results are processes that are likely to provide the best outcomes for patients with DFI.

Specific Antibiotic Agents:


Anti-infective Therapy:

Empiric therapy of DFIs should ideally be guided by the severity of the infection and the likely microbiology of the wound. Acute, relatively mild infections in patients who have not recently received antibiotic therapy can often be solely directed at aerobic Gram-positive cocci. Infections that are chronic, moderate or severe, or that occur in patients who have failed previous antibiotic treatment should usually be more broad spectrum. The need to cover MRSA (or ESBL) isolates depends on the likelihood of these pathogens in any given patient. Definitive therapy, to complete the appropriate course, should be based on both the clinical response to empiric therapy and the results of the culture and sensitivity report. In polymicrobial infections, some organisms may represent contaminants or colonizers, and may therefore not need to be specifically covered by the antibiotic regimen.

Pancreatic Cancer : Treatments

What are Symptoms of Pancreatic Cancer?

Pancreatic Cancer Surgery India, Low Cost Pancreatic Cancer Treatment India, Pancreatic Cancer Surgery Benefits India. The most common early symptoms can include:

Pain in the stomach area that may spread to your back
Unexplained weight loss

Other and later symptoms

Bowel disturbances
Fever and shivering

What are the Types of Pancreatic Cancer?
There are two types of pancreatic cancer, that of the exocrine gland and that of the endocrine gland. About 95 percent of pancreatic cancers begin in the exocrine cells of the pancreas.

Exocrine tumors: Most tumors affecting the exocrine gland are called adenocarcinomas. This type of cancer forms in the pancreas ducts. Treatment for these tumors is based on stage of growth.
Ductal Adenocarcinoma – Adenocarcinomas account for over 75% of all pancreatic cancers, and develop from cells that line the ducts which carry the digestive juices into the main pancreatic duct and then into the duodenum. They can develop anywhere within the pancreas. Most commonly, they are found in the head of the pancreas.
Acinar Cell Carcinoma – This is a very rare cancer (about 1% of pancreatic cancers) and develops in the acinar cells that produce and secrete the digestive enzymes. These tumours may produce excessive amounts of the digestive enzymes and so cause distinct symptoms, including unusual skin rashes and joint pain.
Adenosquamous Carcinoma – These tumours are similar to adenocarcinomas in that they form in glands, but the cells flatten as they grow.
Intraductal Papillary Mucinous Neoplasm/Tumours – Also known as IPMNs (or IPMTs), they form in the main pancreatic duct or in its side branches. They form finger like projections known as papillae into the duct and secrete a large amount of mucous which often causes the duct to expand or dilate. They account for about 3% of cases. They may be benign when first diagnosed, but if left unchecked, may change into a more aggressive and invasive form of cancer.
Mucinous Cystadenocarcinoma – A rare malignant cyst filled with mucin – a thick gel like fluid – predominantly affecting the tail of the pancreas and not the ductal system. They account for 1 – 2% of exocrine tumours and almost exclusively are found in women (middle-aged). If the cyst (which can grow very large -up to 20 cm) presses on the bile duct it will cause obstructive jaundice.
Pancreatoblastoma – A very rare childhood tumor (predominantly found in children under 10). It is even more rarely seen in adults. Mainly made up of acinar cells, some show ductal elements and even endocrine cells. Its features overlap those of acinar cell carcinoma.
Serous Cystadenocarcinoma – A cyst filled with thin, watery fluid. These are almost always benign tumors, which although can grow quite large, do not spread to other parts of the body. Cystic tumors represent about 2% of all pancreatic cancers. Most are benign, but their growth will impact on other structures and cause symptoms such as jaundice if they press on the bile duct.
Solid and Pseudopapillary Tumors – These are rare, benign or low grade malignant tumours more commonly seen in girls and young women. They can occur anywhere, but most frequently they are found in the tail and consist of both solid and cystic parts. They have a good prognosis if they can be completely removed since they can spread.
Endocrine Tumors: These tumors are less common and are most often benign. Though rare, cancer stemming from an endocrine tumor (cystadenocarcinoma) affects the hormone-producing cells. There are different types of Endocrine tumors.
Gastrinomas (Zollinger-Ellison Syndrome) – These produce too much gastrin, causing peptic ulcers in the stomach or duodenum. This leads to severe pain, bleeding causing black tarry stools (faeces), and diarrhoea. They occur in the pancreas and in the duodenum. These tumors are mostly malignant, meaning cancerous. The majority of cases appear to develop for unknown reasons, but about 25% of cases are associated with the MEN-1 syndrome, and as such are inherited as part of a genetic syndrome. Improved early screening in at risk groups may lead to earlier diagnosis when the tumors are still benign.
Glucagonomas – These produce too much of a hormone called glucagon. This causes a very specific type of skin rash (redness, ulceration and scabbing), anaemia, mouth ulcers and diarrhoea. These tumors are mostly malignant, meaning cancerous.
Insulinomas – These produce too much insulin, causing weakness, loss of energy, dizziness and drowsiness. These tumors are nearly always benign, meaning non-malignant and non-cancerous. Insulinoma is the most common and well-known islet cell tumor of the pancreas, accounting for more than 75-80% of sporadic functioning pancreatic islet cell tumors.
PPomas – These are also usually malignant, meaning cancerous.
Somatostatinomas – Produces too much of a hormone called somatostatin. This causes gall stones, diabetes and diarrhoea with bulky fatty and smelly stools (steatorrhoea). These tumors are mostly malignant, meaning cancerous.
VIPomas – Produces too much of a hormone called VIP. This causes a great deal of watery diarrhoea, flushing of the face, and high blood pressure. These tumors are mostly malignant, meaning cancerous.

Stapler Haemorrhoidectomy: Treatments

What is haemorrhoidectomy?

It is a surgery to remove haemorrhoids (Piles). You will be given general anaesthesia or spinal anaesthesia so that you will not feel pain.

What is the stapled haemorrhoidectomy procedure?

Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy, is a surgical procedure that involves the removal of abnormally enlarged hemorrhoidal tissue, followed by the repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position. Severe cases of hemorrhoidal prolapse will normally require surgery. Newer surgical procedures include stapled transanal rectal resection (STARR) and procedure for prolapse and hemorrhoids (PPH).

Why is it done?

It is appropriate when you have:

Very large internal haemorrhoids (Piles)
Internal haemorrhoids that still cause symptoms after nonsurgical treatment
Bleeding during or after the defecation
Large external haemorrhoids that cause significant discomfort and make it difficult to keep the anal area clean
Both internal and external haemorrhoids

How long does the procedure take?

Stapled haemorrhoidectomy employs a unique circular stapler which reduces the degree of prolapse by excising a circumferential strip of mucosa from the proximal anal canal. This has the effect of pulling the haemorrhoidal cushions back up into their normal anatomical position. Usually the patient will be under general anaesthetic, but only for around 30 minutes.

How long does it take to recover from Piles operation?

Due to the low level of post-operative pain and reduced analgesic use, patients will usually be discharged either the same day or on the day following surgery. Most patients can resume normal activities after a few days when they should be fit for work. The first bowel motion is usually on day two and should not cause any great discomfort. Staples may be passed from time to time during defecation. This is normal and should not be a cause for concern.

Surgical Sperm Retrival

Surgical Sperm Retrival:

Azoospermia meaning absence of Sperm in the semen. This can commonly Obstructive Azoospermia because of block in the epididymis or in the vas either because of injury, infection or surgery. Azoospermia could also be caused by failure of production of sperm called Non obstructive azospermia. In these case Sperms can be retrieved by surgical techniques.

Microsurgical Epididymis Sperm Aspiration (MESA): By this technique epididymis is opened by fine dissection and sperms are aspirated by a fine needle from the epididymis. It is a day care procedure, done in the operation theater with facility of sperm freezing.

Testicular Sperm aspiration (TESA): This is similar to the other technique but the testes is aspirated from the testes. Finding good number of sperm in testes is not as good as in epididymis.

Sperm extracted in these methods are frozen and later used for Intra Cytoplasmic Sperm injection ICSI.

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Fortis Hospital

Polycystic ovary syndrome (PCOS): Treatments

Polycystic ovary syndrome (PCOS) is a common condition affecting 6-7% of women in the reproductive age group. This syndrome is often diagnosed if any two of the following three symptoms or signs are present: absence of periods or irregular periods associated infrequent or no release of eggs every cycle or every month (anovulation or oligo-ovulation), a raised level of male hormone (testosterone) with presence or absence of associated symptoms such as acne, oily or greasy skin, excess hair growth and presence of polycystic ovaries (ovaries with many small cysts of 2-9 mm in size) on ultrasound scan. Although polycystic ovaries are seen in 20 – 33% of women, majority of them are healthy, ovulating normally and not having PCOS.

Weight gain or obThe exact cause of PCOS is not yet clear. Whilst PCOS may run in families and several genetic factors have been implicated with its development, not all women with a genetic trait will develop the condition. However, one of the main underlying problems appears to be ‘insulin resistance’. This means that cells in the body such as muscles are resistant to the effect of a normal level of the insulin hormone secreted by the pancreas. Insulin is a hormone that is responsible for control of the blood sugar in your body. The resistance to the insulin effect in these individuals is compensated by an increased production of insulin to keep the level of sugar in the blood normal. The resultant increase in insulin levels in the blood act on the ovaries as well leading to increased production of the male hormone testosterone. A high level of testosterone slows the normal development of follicles or eggs in the ovaries resulting in an abnormally large number of small follicles, which remain immature and subsequent ovulation (release of egg) is hampered.

Short term and long term problems associated with PCOS:

Weight gain or obesity is not a consequence of PCOS however obesity or excess weight gain tends to worsen the manifestation of this syndrome. Excess body fat can also make insulin resistance worse, leading to further elevations in blood insulin concentrations with a progressive burn out of the gland producing the hormone.

Women with PCOS may develop symptoms in their late teens or 20s. Symptoms can vary from mild to severe and may change over the years. Apart from period related problems, which affect 7 in 10 women affected with PCOS, unwanted hair growth may occur over face, lower abdomen or chest depending on the degree of the rise in testosterone levels. Acne and thinning of scalp hair may also occur. 40% of women are obese and this may be secondary to increased insulin levels. Because of the disturbance in ovulation associated with PCOS, most women experience subfertility although majority of them conceive following treatment of stimulation of the ovaries using fertility drugs.

Nearly 10-20% of women with PCOS develop diabetes at some point in their life. The risk is increased if women are obese (body mass index more than 30), have a strong family history of type 2 diabetes or are above 40 years of age. Women who have been diagnosed as having PCOS are more likely to develop diabetes during pregnancy. A sleeping problem called sleep apnoea, a condition associated with snoring, is also more common than average in women with PCOS. They are also at increased risk of having a stroke and heart disease in later life because of the problems described above in addition to other associated conditions such as obesity, raised blood pressure and increased cholesterol levels. If women suffer from infrequent periods particularly with intervals between menstrual cycles of more than three months, the risk of pre-cancerous changes and subsequent cancer of the lining of the womb is higher than women having regular menstrual cycles. Because of these associated risks women having PCOS should have regular checks for blood sugar, cholesterol levels and blood pressure to detect any abnormality as early as possible. They should also be advised to have at least four menstrual cycles, which could be induced by taking either the ordinary contraceptive pills or progesterone tablets as prescribed by a doctor to prevent any changes within the lining of the womb.

Curing PCOS:

Whilst there is no cure for PCOS, life style and dietary modification may alleviate some of the symptoms and long term consequences. Weight loss and regular exercise in obese women have been shown to improve fertility and lowering of androgen levels and associated symptoms of hair growth and acne. It also reduces the long term risk of diabetes, heart disease and even cancer of the lining of the womb. Even a small reduction in weight of about 2-5% has been shown to improve the ovulation and resumption of menses. Dietary modification such as low calorie diet, avoiding sugary drinks and also snacks between meals are useful to complement the efforts to reduce weight. Small frequent low calorie diet may be an alternative to avoid persistent increase in insulin levels, which is the key mechanism for the development of most symptoms of PCOS (make your portions small). Daily moderate sweat inducing exercise lasting for at least 30 minutes is one of the most important lifestyle measures to reduce the risks of both the short term and long term consequence of PCOS.

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Fortis Hospitals

Endometriosis : Treatments

The lining of the womb or uterus is called endometrium. Endometriosis is an estrogen hormone-dependent condition that is characterized by the presence of ectopic endometrial tissue in places within the body but outside of the uterus. The disease state and symptoms can be modified by pregnancy, breast feeding and menopause.

The pathogenesis of endometriosis remains an enigma in gynaecology and a topic of heated debate. There are 2 distinct entities:

Endometriosis (external – outside of the uterus)
Adenomyosis (in the muscle of the uterus).


A good clinical history and a thorough clinical examination help point in the direction of the correct diagnosis. To confirm the diagnosis, a woman will be advised to undergo a pelvic ultrasound assessment and laparoscopy (keyhole camera procedure) which is considered the “gold standard” tool. Other sophisticated tests such as MRI, intravenous urography (IVU), barium enema (X-ray procedure) may be required in some women with severe disease.

Endometriosis can be managed either with the help of drugs or with surgery. The drugs used for the management are geared towards reducing the impact of the oestrogen hormone.

Unfortunately, one cannot completely cure endometriosis or eradicate the disease by surgery or medications.
Following surgery for mild, moderate or severe disease, the chances of recurrence may be as high as 50% in 2 – 3 years. Also, symptoms of pain may recur once the medications are stopped.

Combined oral contraceptive pill (COCP)
Progesterone only pill
Gonadotropin releasing hormone agonist (GnRHa e.g. Zoladex, Prostap, Luprolide acetate etc)
Mirena IUS (Progesterone loaded IUCD)

Initial management of pain symptoms is generally with painkillers or analgesics. If a woman is not desirous of fertility and pain is her main symptom, the use of the combined oral contraceptive pill continuously for 3 – 6 months followed by short breaks of 7 days could help relieve the symptoms.
In women that are overweight or obese, those that have a family history of blood clots, or those that smoke and those with an altered liver function, the use of oestrogen containing pills is contraindicated. In such cases, one may use the progesterone only pill continuously for 3 – 6 months.

GnRH analogues are injections that will be given to cases with moderate to severe endometriosis. These injections are given either or a monthly or 3 monthly basis. The GnRH analogues temporarily switch off the ovaries thereby reducing the impact of oestrogen on the endometriotic deposits and causing a regression in their size and improvement in the pain symptoms. Women may need to use a small dose of hormone replacement therapy (HRT) during the GnRH analogue treatment to combat symptoms of low oestrogen such as hot flushes, night sweats, mood swings and irritability.
The Mirena IUS is a progesterone (levo-norgestrel) loaded intra-uterine device that has been found to have a beneficial impact on symptoms of pain.
Unfortunately, none of the above will allow a woman to conceive or fall pregnant during treatment.
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Fortis Hospitals

Chronic pelvic pain:Treatments

Chronic pelvic pain is defined as pain the abdomen / pelvis below the level of the belly button (umbilicus) that has been present for 6 months or more.

It may or may not be associated with menses or periods. It is not a disease but a symptom that can be caused several different conditions.


Detailed history
Clinical examination
Blood tests
Urine test
Pelvic Ultrasound
Laparoscopy (key hole camera procedure through the belly button)
Others: CT scan, MRI scan.

Medical Managements:

Pain killer tablets (Paracetamol, Ibuprofen, etc)
Hormonal manipulation (Endometriosis / fibroids)
Surgical treatment of endometriosis / fibroids / adhesions or scarring
Relaxation techniques / hypnosis
Psychosocial support and counselling (Individual therapy / group therapy / patient support groups)

Article by
Fortis Hospitals

Pelvic inflammatory disease (PID); Treatments

Pelvic inflammatory disease (PID) is a disease of the upper genital tract seen in women between 15 – 45 years of age and involves uterus (womb), fallopian tubes, ovaries and other areas within the pelvis. The infection affects the surface lining in all the above organs leading to damage with short and long term health implications.
The true prevalence of PID is unclear but it is known that nearly 1:50 women will see their GP with some symptoms due to the disease process. The common organisms associated with PID are Chlamydia trachomatis and Neisseria gonorrhoea. The other organisms that cause pelvic infection include Anaerobes, Mycoplasma genitalium, genital Tuberculosis etc.
Screening programes have revealed that asymptomatic Chlamydial infection can be picked up in as many as 6% women seeking contraception advice and up to 5% women undergoing cervical smear test (PAP smear). Overall screening programmes have shown a pick up rate of between 1-17% in asymptomatic women.

The doctor will obtain a history and perform a clinical examination during which culture swabs will be taken from cervix (neck of the womb) and vagina to confirm the type of infective organism. This will be followed by blood tests, pelvic ultrasound scan and sometimes laparoscopy (camera procedure through the belly button). Genital Tuberculosis of the uterus can be confirmed following laboratory analysis of the endometrium (biopsy of the lining of the womb). Currently there is no single test that will accurately diagnose the presence of PID.

Medical Management:

Prevention – Safe sex education in schools and colleges, changing or modifying behaviour, programmes for screening of infection in the population
Oral drugs – prompt treatment for the infected individual with appropriate drugs for a prescribed time period
Contact tracing of sexual partners and treatment
Hospitalization, Intravenous drug therapy and surgery (laparoscopic / open) for severe cases and especially those that develop abscesses in the tubes and ovaries and also that fail to respond to standard oral drug therapy
In the future vaccination for prevention

Article by

Fortis Hospitals

Peripheral Artery Disease (PAD): Treatments

The ankle-brachial index test is a quick, noninvasive way to check your risk of peripheral artery disease (PAD). Peripheral artery disease is a condition in which the arteries in your legs or arms are narrowed or blocked. People with peripheral artery disease are at a high risk of heart attack, stroke, poor circulation and leg pain.

The ankle-brachial index test compares your blood pressure measured at your ankle with your blood pressure measured at your arm. A low ankle-brachial index number can indicate narrowing or blockage of the arteries in your legs, leading to circulatory problems, heart disease or stroke. The ankle-brachial index test is sometimes recommended as part of a series of three tests, including the carotid ultrasound and abdominal ultrasound, to check for blocked or narrowed arteries.

The ankle-brachial index test is done to check for peripheral artery disease (PAD), a condition in which the arteries in your legs or arms are narrowed.

Ask your doctor if you should have this test if you are age 50 or older and have any of these risk factors for PAD:

Being a current or former smoker
Overweight (a body mass index of 25 or greater)
High blood pressure
High cholesterol

If you’ve already been diagnosed with PAD, your doctor may recommend having an ankle-brachial index test to see if your treatment is working or if your condition has worsened. If you have symptoms of PAD, your doctor may suggest you have an exercise ankle-brachial index test to determine if your symptoms are due to PAD or other conditions, such as spinal stenosis. In an exercise ankle-brachial index test, you walk on a treadmill for a short time before your ankle-brachial index is measured.
When the ankle-brachial index test is complete, your doctor calculates your ankle-brachial index by dividing the higher of the two blood pressure measurements at the arteries near your ankle by the higher of the two blood pressure measurements at your arms. Based on the number your doctor calculates, your ankle-brachial index may show you have:

No blockage (1.0 to 1.4). An ankle-brachial index number in this range suggests that you probably don’t have peripheral artery disease. But if you have certain risk factors, such as diabetes, smoking or a family history of PAD, tell your doctor so that he or she can continue to monitor your risk.
Borderline (0.9 to 0.99). If your ankle-brachial index number is less than 1.0, you may have some narrowing of the arteries in your leg. People with an ankle-brachial index of 0.9 or lower may have the beginnings of PAD. Your doctor may then monitor your condition more closely.
Mild blockage (0.8 to 0.89). An ankle-brachial index in this range shows you’re in the early stages of PAD. Your doctor may suggest medications or lifestyle changes to treat your condition.
Moderate blockage (0.5 to 0.79). An ankle-brachial index number in this range shows that you have more significant blockage of your ankle and leg arteries. You may have noticed some pain in your legs or buttocks when you exercise.
Severe blockage (less than 0.5). If your ankle-brachial index number is in this range, your leg arteries are significantly blocked and you may have pain in your legs even while resting. An ankle-brachial index of less than 0.4 suggests severe PAD.
Rigid arteries (more than 1.4). If your ankle-brachial index number is higher than 1.4, this may mean that your arteries are rigid and don’t compress when the blood pressure cuff is inflated. You may need an ultrasound test to check for peripheral artery disease instead of an ankle-brachial index test, or a toe-brachial index test, in which the blood pressures in your arm and big toe are compared.

The above numbers are based on guidelines Mayo Clinic uses. The guidelines suggested by the American Heart Association and the American College of Cardiology differ slightly. They suggest a normal ankle-brachial index ranges from 1.0 to 1.4, a borderline index ranges from 0.91 to 0.99, and an abnormal index is 0.9 or lower. If you have an exercise ankle-brachial index test, the ranges for results differ. Talk to your doctor about what your results mean.

Depending on the severity of your blockage, your doctor may recommend lifestyle changes, medications or surgery to treat PAD. Talk to your doctor about your options. You may also need additional imaging tests to see what treatment is best for you.

The test may not adequately measure the ankle-brachial index if you have severe diabetes or calcified arteries with significant blockage. Instead, your doctor may need to read your blood pressure at your big toe (toe-brachial index) to get an accurate test result if you have either of these conditions.

Article by;
Fortis Hospitals