![]() The nearest distance between the dorsal most prominence of the navicular bone and dorsalis pedis pulse was measured while palpating in a posterior-lateral direction towards the lateral malleolus in an attempt to define a more reliable bony anatomical landmark.įorty one random, consecutive subjects who were admitted to the hospital under the care of the surgical team were selected as our subjects. Instead, we chose the dorsal most prominence of the navicular bone as our bony landmark since this is the most prominent aspect of the dorsum of the foot. Since the extensor hallucis longus tendon maintains a lengthy course, this landmark provides a vague guideline for palpation of the dorsalis pedis pulse. 6 In contrast, only a soft tissue boundary as defined medially by the extensor hallucis longus tendon running over the dorsum of the foot, has been defined as a guide for the location of the dorsalis pedis artery. A specific landmark, notably a groove between the medial malleolus and the Achilles tendon, is described for the palpation of the posterior tibial pulse. We have observed increased variability among house staff when examining for the dorsalis pedis arterial pulse when compared with the posterior tibial arterial pulse. 4 In fact, accuracy of pulse palpation has been most associated with level of the examiner’s experience. 2, 3 Investigator variability is also a confounder of accurate pulse detection and includes factors such as fingertip sensitivity, anatomic knowledge, or sensation of the examiner’s own fingertip pulsation. 1 Unreliance among investigators stems from discrepancies related to arterial size, amount of subcutaneous fat, oedema, or neurovascular diabetic changes. Although a correlation between the ability to palpate pulses and the degree of systolic perfusion pressure has been established, controversy surrounds its accuracy. Reliability of the examination may be increased as to the patency of the dorsalis pedis artery by using this dependable anatomic landmark.Įxamination of pedal pulses remains a useful clinical tool when evaluating peripheral circulation. 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.Ĭonclusion: The dorsal most prominence of the navicular bone provides a bony landmark to readily locate the dorsalis pedis artery. 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. 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. Results: The dorsalis pedis artery was palpable in 78% of extremities and present by Doppler ultrasound in 95%. ![]() ![]() Measurements were confirmed by two separate examiners blinded to each others’ results. 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. Methods: Forty one consecutive patients admitted to a general surgery service of a tertiary medical centre within a two month period were examined. In this paper a novel method of locating the dorsalis pedis pulse by physical examination is described. 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. Introduction: The unreliability of the pulse examination of the foot has primarily been due to variability of technique between examiners. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |