Purpose Pedal acceleration time (PAT) is a ultrasound assessment for lower limb perfusion. It is useful in patients with digital amputations, open wounds, or non-compressible vessels, where conventional measurements may not be possible. Emerging data confirms it correlates with wound healing and amputation-free survival. However, it is unclear to what extent it can be accurately and reliably repeated. The aim of this study was to determine the inter- and intra-rater reliability of PAT measurements. Methodology Ten patients from a tertiary diabetic foot/chronic limb threatening ischaemia clinic were recruited in Oct 2023. 3 trained sonographers independently conducted PAT measurements 3 times each on 3 pedal arteries. The inter-rater reliability was assessed as the percentage contribution of raters and replicates to variability. The intra-rater reliability was quantified by the coefficient of variation. Intraclass correlation was used to summarise the combined effect of raters and repeat measures by raters. Results The contribution to variance by different raters was ≤0.4%, while as expected the variation amongst patients dominated total variation (≥88.1%). Coefficient of variation ranged from 10.8-12.2%, suggesting high intra-rater reliability. The intraclass correlation ranged from 0.88-0.90 indicating good to excellent reliability of PAT. Conclusion This study indicates that PAT can be reliability measured with high levels of inter- and intra-rater reliability. These small differences in PAT values are unlikely to tangibly change clinical interpretation. Future studies should seek to validate these findings in larger cohorts and assess the effect of the learning curve on the reliability of PAT measurements.