Anatomical study of Dorsalis pedis Artery and Its Clinical Correlations

INTRODUCTION To evaluate patients with arterial disease, palpation of peripheral arterial pulse is commonly used. In lower limb, palpation of dorsalis pedis artery is used to evaluate the arteriosclerotic diseases. Dorsalis pedis artery is the main source of blood supply to the foot. A knowledge about the origin, course and branching pattern of this artery is essential, as it forms the stem for one of the major myocutaneous flaps, used for ankle surgeries in plastic and reconstructive surgeries. Fifty free lower limbs were dissected and the origin, course and branching pattern of dorsalis pedis artery were studied. 50 free lower limbs were collected from the anatomy dissection hall. The dorsalis pedis artery was dissected and its origin, course and branching pattern were studied. In the present study dorsalis pedis artery was found to have a normal course and branching pattern in 56%, variation in origin in 8%, variation in branching pattern in 16%, absence of the artery in 2% and duplication in 2% of the specimens studied. As variation in dorsalis pedis artery is not uncommon, it is essential to have a sound knowledge about the artery. It is advisable to have preoperative angiography for any abnormality, to prevent risks during surgical intervention. KEY MESSAGE The vascularity irrigation of the dorsum of the foot is mainly from the dorsalis pedis artery (DPA). Palpation of foot pulses mainly DPA is used to evaluate patients with arterial diseases. This vessel provides the basis of the anatomical rationale for surgically raising a flap of skin over the dorsum of the foot, which can then be used to resurface other areas of the body. With changing lifestyle, and increasing stress, mankind is more liable for diseases like diabetes and hypertension. Diabetic neuropathy leads to foot infections and ischemia, leading to the risk of major amputations. In the efforts of salvaging the ischemic limb DPA bypass acts as a major role. The dorsalis pedis artery(DPA) with its major branches is the preferentially used recipient vessel.The myocutaneous dorsalis pedis arterialised flap can be safely used as an island flap, to cover the ankle or heel and as a free flap for palm defects. Hence it was decided to study dorsalis pedis artery. MATERIALS AND METHODS Fifty preserved lower extremities were used for the study. These lower limbs were dissected carefully to explore the dorsalis pedis artery, and its branches were traced and painted for clear view and photographed. In case of variations in the course and branching pattern of dorsalis pedis artery, further exploration was made. In cases of variant origin of the dorsalis pedis artery, the posterior compartment was explored and all the data were documented. RESULTS The following observations were made after the dissection of the dorsalis pedis artery was carried out in all lower limbs. The findings of this present study were grouped as follows: 1. Normal course of the dorsalis pedis artery. 2. Variant origin of the dorsalis pedis artery. 3. Variation in the course of the dorsalis pedis artery. 4. Variation in the branching pattern of the dorsalis pedis artery. 5. Absence of the arcuate artery. 6. Absence of dorsalis pedis artery. 1. Normal course of the dorsalis pedis artery The chief artery of the dorsum of foot is the dorsalis pedis artery. Most often, the anterior tibial artery continues as the dorsalis pedis artery. The anterior tibial artery enters the foot under the inferior extensor retinaculum and runs distally towards the inter-space between the first and second toes. The dorsalis pedis artery divides into two branches in the first dorsal intermetatarsal space. The large branch is the first dorsal metatarsal artery (deep plantar artery) that disappears between the two heads of the first dorsal interosseous muscle, into the sole of the foot. A small-sized arcuate artery, runs transversely across the dorsum and provides most of the dorsal metatarsal arteries, usually two to four. The dorsal metatarsal arteries communicate with the plantar metatarsal arteries and end as tiny dorsal digital arteries. Branches from the dorsalis pedis artery are: 1. Medial and lateral tarsal arteries. 2. Arcuate artery. 3. First dorsal metatarsal artery. In the present study, out of 50 free lower limbs, 28 of them had normal course arising from anterior tibial artery and gave all the above said branches as in [Table/Fig 1].