Venous leg ulceration (VLU) remains one of the most common chronic wounds managed in community nursing (Guest, 2020), yet outcomes across the UK continue to vary dramatically. Despite decades of evidence confirming that compression therapy is the cornerstone of treatment, healing rates remain unacceptably poor in many areas (Guest et al, 2018). At the centre of this problem sits a test that was originally designed to support vascular assessment but which in practice has become something far more powerful: the ankle brachial pressure index (ABPI).