From the Guidelines
To palpate the dorsalis pedis pulse, place your index and middle fingers on the dorsal surface of the foot between the extensor tendons of the first and second toes, just lateral to the extensor hallucis longus tendon, as recommended by the 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS guideline for the management of lower extremity peripheral artery disease 1. This assessment is crucial for evaluating peripheral circulation, particularly in patients with suspected peripheral vascular disease, diabetes, or during lower extremity injury assessment. Some key points to consider when palpating the dorsalis pedis pulse include:
- Apply gentle pressure against the underlying tarsal bones, as excessive pressure may obliterate the pulse.
- The patient should be lying or sitting with their foot relaxed in a slightly extended position.
- If you cannot locate the pulse immediately, move your fingers slightly laterally or medially while maintaining contact with the skin.
- Use the pads of your fingers rather than your fingertips for better sensitivity. The dorsalis pedis pulse is normally easily palpable but may be congenitally absent in approximately 10% of healthy individuals, as noted in the ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease 1. A diminished or absent pulse when previously present may indicate arterial insufficiency requiring further evaluation, and additional diagnostic tests such as ankle-brachial index (ABI) measurement or hand-held Doppler evaluation of the flow signals from both foot arteries (dorsalis pedis and posterior tibial) may be necessary, as suggested by the 2012 specific guidelines for the diagnosis and treatment of peripheral arterial disease in a patient with diabetes and ulceration of the foot 1.
From the Research
Palpation Technique
To palpate the dorsalis pedis pulse, the following steps can be taken:
- Use the dorsal most prominence of the navicular bone as a landmark 2
- Measure the distance from this landmark to the dorsalis pedis pulse by palpation
- Compare the measurements to Doppler ultrasound for confirmation
Location of Dorsalis Pedis Artery
The location of the dorsalis pedis artery can be determined by:
- Measuring the distance from the dorsal most prominence of the navicular bone 2
- Using Doppler ultrasound to confirm the presence and location of the artery
- The mean distance from the landmark to the dorsalis pedis artery was found to be around 9.8-11.5 mm 2
Reliability of Palpation
The reliability of palpation can be increased by:
- Using a consistent landmark, such as the dorsal most prominence of the navicular bone 2
- Comparing measurements to Doppler ultrasound for confirmation
- Having multiple examiners perform the palpation to ensure consistency 2
Diagnostic Tools
Other diagnostic tools that can be used in conjunction with palpation include: