Descriptive anatomical study of the dorsalis pedis artery for use in clinical and surgical procedures

Abstract

Variations of the dorsalis pedis artery (DPA) are quite common, and may result in complications and misdiagnosis. A variation that results in a deviated DPA from the anterior ankle or one with an abnormal origin may lead to misdiagnosis of peripheral arterial disease due to an undetected/absent pulse. Complications that may occur include haemorrhages caused by severed arteries as a result of variations that lead to changes in positions/locations on the foot from their known origins. Non-viable flaps and grafts may be selected due to variations that result in reduced arterial supply and changes in calibres of blood vessels. As a result of these complications suggestions of amputations may be considered due to misdiagnosis of an absent pulse and the presence of peripheral arterial disease. The DPA is the main blood supply of the dorsum of the foot and the continuation of the anterior tibial artery. The DPA branches into the medial and lateral tarsal arteries, the arcuate artery (which branches into the second to fourth dorsal metatarsal arteries), the first dorsal metatarsal artery and deep plantar artery. The DPA is clinically essential for the detection of pedal pulsation. DPA and its branches can be used as flaps/pedicles for bypass grafts during plastic and reconstructive repairs, in complications that involve amputations of ischaemic limbs in diabetic patients. The current study investigated the anatomy of DPA, its branching pattern and position on the anterior ankle joint in a cadaveric sample and by using angiograms. The proposed sample size for the cadaveric component of the study was 200 feet from 100 formalin-fixed adult cadavers, while only 18 cross-sectioned computed tomography (CT) scans were used from a total of 21 scans. The cadaveric study concluded that, a common branching pattern of the DPA was found in an incidence of 11.56% in 147 feet, while fourteen (14) branching patterns of the DPA (A to N) were recorded. The findings of the current study suggest that variations of the DPA are common. Results from the cadaveric study show the average distance of the intermalleolar line (LM-MM) was reported as 69.30 mm. The average distances from the lateral and medial malleoli to the origin of the DPA were 47.19 mm and 39.61 mm, respectively. The average diameter of the DPA was found as 2.37 mm. Comparisons were made between the cadaveric study and angiogram study, with both studies revealing that the position of the DPA on the ankle was slightly located on the medial side. Vascular mapping of the small and distal arteries of the foot remains a challenging task to perform. The DPA remains at risk of injury during surgical interventions such as reconstructive and plastic repairs, as well as ankle arthroscopy. Thorough knowledge of the anatomy of the DPA and its branches is essential in the correct and accurate vascular mapping of the distal arteries of the foot for teaching, as well as in clinical and surgical interventions. This knowledge will assist clinicians and surgeons in the correct detection of the pedal pulsation, thus reducing occurrence of misdiagnosis. This knowledge will also assist surgical planning prior to surgical interventions such as ankle arthroscopy, in preventing risk of injuries to the DPA, as well as finding viable bypass grafts in treating ischaemic limbs, thus reducing lower limb amputations.