From the Guidelines
To palpate the posterior tibial pulse, position the patient lying down with their foot slightly relaxed and place your fingertips behind and slightly below the medial malleolus, as described in the context of assessing peripheral circulation 1. The posterior tibial pulse is an important indicator of peripheral circulation, and its assessment is crucial in patients with vascular disease, diabetes, or lower extremity injuries.
- Key steps to palpate the posterior tibial pulse include:
- Positioning the patient in a comfortable lying-down position
- Locating the medial malleolus, the bony prominence on the inner ankle
- Placing fingertips behind and slightly below the medial malleolus
- Applying gentle to moderate pressure against the tibia bone using the index and middle fingers
- Feeling for the pulse in the groove between the medial malleolus and the Achilles tendon
- It is essential to use the correct amount of pressure, as pressing too hard may obliterate the pulse 1.
- If difficulty is encountered in locating the pulse, trying slightly dorsiflexing the patient's foot or repositioning the fingers may be helpful.
- Comparing the pulse with the opposite side to assess symmetry is also a critical step in evaluating peripheral circulation. The assessment of the posterior tibial pulse is part of a complete peripheral vascular examination and provides valuable information about blood flow to the foot, with a diminished or absent pulse potentially indicating arterial insufficiency requiring further evaluation, as noted in the context of peripheral circulation assessment 1.
From the Research
Palpation of Posterior Tibia Pulse
To palpate the posterior tibia pulse, the following steps can be taken:
- Locate the posterior tibial artery, which runs posterior to the medial malleolus (the bony bump on the inner side of the ankle) 2
- Use the index and middle fingers to press gently but firmly on the artery, with the fingers pointing downwards towards the foot 3
- Feel for the pulse, which should be a gentle tapping or throbbing sensation under the fingers
Challenges in Palpation
Palpation of the posterior tibia pulse can be challenging in certain cases, such as:
- Peripheral arterial disease (PAD), where the pulse may be weak or absent due to stenosis or occlusion of the arteries 4, 5, 6
- Medial arterial calcification, which can cause the ankle-brachial index (ABI) to be falsely elevated, making it difficult to diagnose PAD 5, 2
- Chronic kidney disease (CKD), where the ABI and toe-brachial index (TBI) may have low sensitivity for detecting PAD 2
Diagnostic Tools
In addition to palpation, several diagnostic tools can be used to evaluate the posterior tibial artery and detect PAD, including:
- Ankle-brachial index (ABI), which measures the ratio of blood pressure in the ankle to blood pressure in the arm 4, 5, 2, 6, 3
- Doppler ultrasound, which uses sound waves to evaluate blood flow in the arteries 4, 5, 6, 3
- Photoplethysmography (PPG), which measures changes in blood volume in the skin 3
- Continuous-wave Doppler ultrasound (CWD), which uses sound waves to evaluate blood flow in the arteries 3