Abstract
Introduction: The unreliability of the pulse examination of the foot has primarily been due to variability of technique between examiners. Whereas the groove between the medial malleolus and the Achilles tendon more readily defines the location of the posterior tibial pulse, the location of the dorsalis pedis pulse remains vague. In this paper a novel method of locating the dorsalis pedis pulse by physical examination is described.
Methods: Forty one consecutive patients admitted to a general surgery service of a tertiary medical centre within a two month period were examined. Using the dorsal most prominence of the navicular bone as a landmark, the distance to the dorsalis pedis pulse in bilateral lower extremities was measured by palpation and compared to Doppler ultrasound. Measurements were confirmed by two separate examiners blinded to each others' results.
Results: The dorsalis pedis artery was palpable in 78% of extremities and present by Doppler ultrasound in 95%. The location of the left dorsalis pedis artery was a mean (SD) 9.8 (1.4) mm by palpation and 11.1 (2.1) mm by Doppler ultrasound from the dorsal most prominence of the navicular bone. The right dorsalis pedis artery was 10.4 (3.4) mm by palpation and 11.5 (0.7) mm from the dorsal most prominence of the navicular bone. No significant differences in location of the dorsalis pedis artery were observed bilaterally between Doppler ultrasound and palpation; No significant differences were observed comparing contralateral dorsalis pedis arteries nor any differences between the examiners' results.
Conclusion: The dorsal most prominence of the navicular bone provides a bony landmark to readily locate the dorsalis pedis artery. Reliability of the examination may be increased as to the patency of the dorsalis pedis artery by using this dependable anatomic landmark.
Full Text
The Full Text of this article is available as a PDF (65.2 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brearley S., Shearman C. P., Simms M. H. Peripheral pulse palpation: an unreliable physical sign. Ann R Coll Surg Engl. 1992 May;74(3):169–171. [PMC free article] [PubMed] [Google Scholar]
- Goss D. E., de Trafford J., Roberts V. C., Flynn M. D., Edmonds M. E., Watkins P. J. Raised ankle/brachial pressure index in insulin-treated diabetic patients. Diabet Med. 1989 Sep-Oct;6(7):576–578. doi: 10.1111/j.1464-5491.1989.tb01231.x. [DOI] [PubMed] [Google Scholar]
- Ison J. W. Palpation of dorsalis pedis pulse. JAMA. 1968 Dec 16;206(12):2745–2745. doi: 10.1001/jama.1968.03150120079038. [DOI] [PubMed] [Google Scholar]
- LUDBROOK J., CLARKE A. M., McKENZIE J. K. Significance of absent ankle pulse. Br Med J. 1962 Jun 23;1(5294):1724–1726. doi: 10.1136/bmj.1.5294.1724. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lawson I. R., Ingman S. R., Masih Y., Freeman B. Reliability of palpation of pedal pulses as ascertained by the kappa statistic. J Am Geriatr Soc. 1980 Jul;28(7):300–303. doi: 10.1111/j.1532-5415.1980.tb00619.x. [DOI] [PubMed] [Google Scholar]
- Lundin M., Wiksten J. P., Peräkylä T., Lindfors O., Savolainen H., Skyttä J., Lepäntalo M. Distal pulse palpation: is it reliable? World J Surg. 1999 Mar;23(3):252–255. doi: 10.1007/pl00013177. [DOI] [PubMed] [Google Scholar]
- Magee T. R., Stanley P. R., al Mufti R., Simpson L., Campbell W. B. Should we palpate foot pulses? Ann R Coll Surg Engl. 1992 May;74(3):166–168. [PMC free article] [PubMed] [Google Scholar]
- Meade T. W., Gardner M. J., Cannon P., Richardson P. C. Observer variability in recording the peripheral pulses. Br Heart J. 1968 Sep;30(5):661–665. doi: 10.1136/hrt.30.5.661. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Quigley F. G., Faris I. B., Duncan H. J. A comparison of Doppler ankle pressures and skin perfusion pressure in subjects with and without diabetes. Clin Physiol. 1991 Jan;11(1):21–25. doi: 10.1111/j.1475-097x.1991.tb00650.x. [DOI] [PubMed] [Google Scholar]