Dorsalis pedis artery
By : Aisha MohammedDefinition
It is one of the small arteries of the lower limb located at the dorsum of foot and often provides its blood supply.
Origin
Dorsalis pedis artery is the continuation of the anterior tibial artery which is the smaller terminal branch of the popliteal artery. The popliteal artery, which is the continuation of the femoral artery which is the continuation of external iliac artery ,which is one of the branches of the common iliac artery, which is a division of the abdominal aorta.
Abdominal Aorta > Right / Left Common Iliac Artery > Right External Iliac Artery > Femoral Artery > Popliteal Artery > Anterior Tibial Artery > Dorsalis pedis artery
Abdominal Aorta > Right / Left Common Iliac Artery > Right External Iliac Artery > Femoral Artery > Popliteal Artery > Anterior Tibial Artery > Dorsalis pedis artery
Arising
It arises at the midway between the two malleoli of the tibia (the medial malleolus) and the fibula(the lateral malleolus) as the anterior tibial artery crosses the ankle joint.
Course
It courses anteriorly over the dorsal aspect of the talus, navicular, and intermediate cuneiform bones.
It is crossed by :
1.Inferior extensor retinaculum
2.The 1st extensor digitorum brevis tendon
It is crossed by :
1.Inferior extensor retinaculum
2.The 1st extensor digitorum brevis tendon
Relations
Laterally: the terminal part of deep fibular nerve and the extensor digitorum longus tendons.
Medially: the tendon of extensor hallucis longus.
Medially: the tendon of extensor hallucis longus.
Branches
1- Deep plantar artery : The major continuation of the dorsal artery. It arises when the dorsalis pedis artery passes to the 1st interosseous space and then deeply passes between the heads of the 1st dorsal interosseous muscle to enter the foot sole to join the lateral plantar artery forming the deep plantar arch. The deep plantar artery resembles the radial artery of the hand, the one that forms the deep palmar arch with the ulnar artery (the deep palmar branch) .
2- Medial tarsal artery : medial branches are 2-3 small twigs which join the medial malleolar network.
3- Lateral tarsal artery : is larger than the medial and arises over the navicular bone. It passes below the extensor digitorum brevis to supply:
1. The extensor digitorum brevis muscle
2. The adjacent tarsal joints
It terminates at the lateral malleolar network.
4- First dorsal metatarsal artery : the last branch of the dorsalis pedis artery before its termination and continuation as the deep plantar artery into the dorsum of the foot. It divides into branches that supply both sides of the hallux and the one side of the 2nd toe(the medial side).
5- Arcuate artery : deep to the extensor tendons, it runs laterally across the bases of the lateral four metatarsals until it reaches the lateral aspect of the forefoot, where its anastomosis may occur with the lateral tarsal artery to form an arterial loop. It gives rise to three dorsal metatarsal arteries, which supply dorsal digital arteries.
Branches of Arcuate artery:
2nd , 3rd , and 4th dorsal metatarsal arteries : these vessels run distally
to the clefts of the toes and are connected to the plantar arch and the plantar
metatarsal arteries by perforating branches.
Dorsal digital arteries : they are divisions of the dorsal metatarsal arteries when each one of them divides into two dorsal digital arteries for the dorsal aspect of the sides of neighboring toes and they end to proximal to the distal interphalangeal joint .
Note : the dorsal metatarsal arteries communicate with the perforating branches from the deep plantar arch and similar branches from the plantar metatarsal arteries.
2- Medial tarsal artery : medial branches are 2-3 small twigs which join the medial malleolar network.
3- Lateral tarsal artery : is larger than the medial and arises over the navicular bone. It passes below the extensor digitorum brevis to supply:
1. The extensor digitorum brevis muscle
2. The adjacent tarsal joints
It terminates at the lateral malleolar network.
4- First dorsal metatarsal artery : the last branch of the dorsalis pedis artery before its termination and continuation as the deep plantar artery into the dorsum of the foot. It divides into branches that supply both sides of the hallux and the one side of the 2nd toe(the medial side).
5- Arcuate artery : deep to the extensor tendons, it runs laterally across the bases of the lateral four metatarsals until it reaches the lateral aspect of the forefoot, where its anastomosis may occur with the lateral tarsal artery to form an arterial loop. It gives rise to three dorsal metatarsal arteries, which supply dorsal digital arteries.
Branches of Arcuate artery:
2nd , 3rd , and 4th dorsal metatarsal arteries : these vessels run distally
to the clefts of the toes and are connected to the plantar arch and the plantar
metatarsal arteries by perforating branches.
Dorsal digital arteries : they are divisions of the dorsal metatarsal arteries when each one of them divides into two dorsal digital arteries for the dorsal aspect of the sides of neighboring toes and they end to proximal to the distal interphalangeal joint .
Note : the dorsal metatarsal arteries communicate with the perforating branches from the deep plantar arch and similar branches from the plantar metatarsal arteries.
Termination
It terminates by anastomosing with the lateral plantar artery to complete the deep plantar arch as the deep plantar artery.
Clinical section
1- Palpation of Dorsalis Pedis Pulse
The dorsalis pedis artery pulse is estimated by a physical examination to the peripheral vascular system.
Dorsalis pedis pulses may be palpated during the feet slightly dorsiflexion. Pulsations of the dorsal artery of foot are easily felt between the tendons of the extensor hallucis longus and the first tendon of the extensor digitorum longus muscles.
Usually, a diminished or absent dorsalis pedis pulse suggests a vascular insufficiency resulting in an arterial disease.
In some healthy people they have a congenital non-palpable dorsalis pedis pulses. Usually, the variation is bilateral.
In such cases, the artery is replaced by an extended perforating fibular artery of a smallest caliber than the typical one of the artery(dorsalis pedis), but still it runs at the same direction.
Note : A weak dorsalis pedis artery pulse may be a sign for an underlying circulatory condition, like the peripheral artery disease (PAD).
PAD : is a condition in which the constricted arteries are reducing the blood flow to the arms or legs.
The dorsalis pedis artery pulse is estimated by a physical examination to the peripheral vascular system.
Dorsalis pedis pulses may be palpated during the feet slightly dorsiflexion. Pulsations of the dorsal artery of foot are easily felt between the tendons of the extensor hallucis longus and the first tendon of the extensor digitorum longus muscles.
Usually, a diminished or absent dorsalis pedis pulse suggests a vascular insufficiency resulting in an arterial disease.
In some healthy people they have a congenital non-palpable dorsalis pedis pulses. Usually, the variation is bilateral.
In such cases, the artery is replaced by an extended perforating fibular artery of a smallest caliber than the typical one of the artery(dorsalis pedis), but still it runs at the same direction.
Note : A weak dorsalis pedis artery pulse may be a sign for an underlying circulatory condition, like the peripheral artery disease (PAD).
PAD : is a condition in which the constricted arteries are reducing the blood flow to the arms or legs.
2- The anterior compartment syndrome
In severe cases of the anterior compartment of leg syndrome, the dorsalis pedis arterial pulse disappears.
The anterior compartment of leg syndrome : it is caused due :
1.Intracompartmental pressure increase, which results from an increased production of the tissue fluid.
2.Soft tissue injury associated with bone fractures is also a common cause.
Note: the early diagnosis is critical.
The symptoms :
-Deep, sore pain at the leg (especially, the anterior compartment).
-The pain increases during the foot dorsiflexion.
- The pain increases by the stretching of the muscles that pass through the compartment during passive ankle plantar flexion.
Treatment :
It should be treated surgically. The surgeon opens the leg anterior compartment by making a longitudinal incision through the deep fascia
Note : The dorsalis pedis artery is absent in approximately 20% of the population.
In severe cases of the anterior compartment of leg syndrome, the dorsalis pedis arterial pulse disappears.
The anterior compartment of leg syndrome : it is caused due :
1.Intracompartmental pressure increase, which results from an increased production of the tissue fluid.
2.Soft tissue injury associated with bone fractures is also a common cause.
Note: the early diagnosis is critical.
The symptoms :
-Deep, sore pain at the leg (especially, the anterior compartment).
-The pain increases during the foot dorsiflexion.
- The pain increases by the stretching of the muscles that pass through the compartment during passive ankle plantar flexion.
Treatment :
It should be treated surgically. The surgeon opens the leg anterior compartment by making a longitudinal incision through the deep fascia
Note : The dorsalis pedis artery is absent in approximately 20% of the population.
Cadavers
Showing the dorsalis pedis Artery (Anterolateral side of leg)
Showing the dorsalis pedis Artery ( Dorsum of the right foot)
References
• Anne MR Agur, Arthur F Dalley, and Keith L. Moore’s Clinically Oriented Anatomy 8th edition/ Copyright © 2018 Wolters Kluwer / pages (778,779-784)
• Adam W. M. Mitchell, Richard L. Drake, and Wayne Vogl’s Gray's Anatomy for Students 4th edition/ Copyright © 2020 Elsevier Inc. / pages (643.Fig. 6.111 - 654 - 665.Fig.
6.135)
• Adam W. M. Mitchell, Richard L. Drake, Richard M. Tibbitts, Paul E. Richardson ,and Wayne Vogl’s Gray's atlas of Anatomy 2nd edition/ Copyright © 2015, 2008 by Churchill Livingstone, an imprint of Elsevier Inc. / pages (335 - 362)
• BD Chaurasia’s Human Anatomy Regional and Applied Dissection and Clinical 8th edition/ Copyright © 2020. CBS Publishers / volume 2 pages (116)
• Lawrence E. Wineski’s Snell's Clinical Anatomy by Regions 10th edition / Copyright © 2019 Wolters Kluwer / pages (558 - 572) • Kenneth P. Moses MD , Pedro B. Nava PhD , John C. Banks PhD , Darrell K. Petersen MBA ‘s Atlas of Clinical Gross Anatomy 2nd edition / Copyright © 2013, 2005, by Saunders, an imprint of Elsevier Inc. / pages ( 561.FIGURE 44.5 - 600.FIGURE 47.9)
• Anatomy of the Dorsalis Pedis Artery The Main Artery of the Foot By Kathi Valeii
Medically reviewed by Scott Sundick, MD For verywellhealth
https://www.verywellhealth.com/dorsalis-pedis-artery-5097663
• Peripheral artery disease (PAD) By Mayo Clinic Staff For Mayoclinic
https://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/symptoms- causes/syc-20350557
• Adam W. M. Mitchell, Richard L. Drake, and Wayne Vogl’s Gray's Anatomy for Students 4th edition/ Copyright © 2020 Elsevier Inc. / pages (643.Fig. 6.111 - 654 - 665.Fig.
6.135)
• Adam W. M. Mitchell, Richard L. Drake, Richard M. Tibbitts, Paul E. Richardson ,and Wayne Vogl’s Gray's atlas of Anatomy 2nd edition/ Copyright © 2015, 2008 by Churchill Livingstone, an imprint of Elsevier Inc. / pages (335 - 362)
• BD Chaurasia’s Human Anatomy Regional and Applied Dissection and Clinical 8th edition/ Copyright © 2020. CBS Publishers / volume 2 pages (116)
• Lawrence E. Wineski’s Snell's Clinical Anatomy by Regions 10th edition / Copyright © 2019 Wolters Kluwer / pages (558 - 572) • Kenneth P. Moses MD , Pedro B. Nava PhD , John C. Banks PhD , Darrell K. Petersen MBA ‘s Atlas of Clinical Gross Anatomy 2nd edition / Copyright © 2013, 2005, by Saunders, an imprint of Elsevier Inc. / pages ( 561.FIGURE 44.5 - 600.FIGURE 47.9)
• Anatomy of the Dorsalis Pedis Artery The Main Artery of the Foot By Kathi Valeii
Medically reviewed by Scott Sundick, MD For verywellhealth
https://www.verywellhealth.com/dorsalis-pedis-artery-5097663
• Peripheral artery disease (PAD) By Mayo Clinic Staff For Mayoclinic
https://www.mayoclinic.org/diseases-conditions/peripheral-artery-disease/symptoms- causes/syc-20350557
