Dorsalis pedis artery
Definition
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).
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 theankle joint.
Course
It courses anteriorly over the dorsal aspect of
the talus, navicular, and intermediate cuneiform
bones. It is crossedby :
1.Inferior extensor retinaculum
2.The 1st extensor digitorum brevis tendon
Abdominal Aorta > Right / Left Common Iliac Artery > Right External Iliac
Artery > Femoral Artery > Popliteal Artery > Anterior Tibial Artery >
Dorsalis pedis artery
Relations
Laterally: the terminal part of deep fibular nerve and the extensordigitorum
longus tendons.
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 anarterial 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
proximal to the distal interphalangeal
joint.
to
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 smaller 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 l e g ( e s p e c i a l l y , t h e 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
approximately20% 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/symptomscauses/syc-20350557