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Examination of pedal pulses remains a useful clinical tool when evaluating peripheral circulation. Although a correlation between the ability to palpate pulses and the degree of systolic perfusion pressure has been established, controversy surrounds its accuracy. 1 Unreliance among investigators stems from discrepancies related to arterial size, amount of subcutaneous fat, oedema, or neurovascular diabetic changes. 2, 3 Investigator variability is also a confounder of accurate pulse detection and includes factors such as fingertip sensitivity, anatomic knowledge, or sensation of the examiner's own fingertip pulsation. 4 In fact, accuracy of pulse palpation has been most associated with level of the examiner's experience. 5
We have observed increased variability among house staff when examining for the dorsalis pedis arterial pulse when compared with the posterior tibial arterial pulse. A specific landmark, notably a groove between the medial malleolus and the Achilles tendon, is described for the palpation of the posterior tibial pulse. 6 In contrast, only a soft tissue boundary as defined medially by the extensor hallucis longus tendon running over the dorsum of the foot, has been defined as a guide for the location of the dorsalis pedis artery. Since the extensor hallucis longus tendon maintains a lengthy course, this landmark provides a vague guideline for palpation of the dorsalis pedis pulse. Instead, we chose the dorsal most prominence of the navicular bone as our bony landmark since this is the most prominent aspect of the dorsum of the foot. The nearest distance between the dorsal most prominence of the navicular bone and dorsalis pedis pulse was measured while palpating in a posterior-lateral direction towards the lateral malleolus in an attempt to define a more reliable bony anatomical landmark.
SUBJECTS AND METHODS
Forty one random, consecutive subjects who were admitted to the hospital under the care of the surgical team were selected as our subjects. The location of the dorsalis pedis artery pulse was recorded using two finger palpation and subsequently verified using a handheld Doppler. The dorsal most prominence of the navicular bone was marked (fig 1). Pulse palpation was...