Pedal pulses, the rhythmic throbbing felt in the arteries of the feet, indicate blood flow to the lower extremities. Assessing them offers insights into an individual’s circulatory health, determining if adequate blood reaches the feet.
Locating Pedal Pulses
Locating the two primary sites, the dorsalis pedis and posterior tibial arteries, is important for effective assessment. The dorsalis pedis pulse is typically found on the top of the foot, often along an imaginary line between the first and second toes, just lateral to the extensor hallucis longus tendon. This pulse can sometimes be difficult to locate due to individual anatomy.
The posterior tibial pulse is situated behind the medial malleolus, the bony prominence on the inner ankle, slightly above the heel. To palpate this pulse, place fingertips behind and slightly below the medial malleolus, often in the groove between the malleolus and the Achilles tendon. Use the index and middle fingers, applying gentle yet firm pressure, while avoiding the thumb to prevent confusion with your own pulse. Excessive pressure can obliterate a subtle pulse.
Assessing Pedal Pulse Characteristics
Once a pedal pulse is located, its characteristics are assessed, including rate, rhythm, and strength. While rate (beats per minute) and rhythm (regular or irregular) are noted, pulse strength is particularly relevant. Pulse strength is often graded using a scale, which can vary between systems, but commonly ranges from 0 to 4+.
On a 0-4+ scale, 0 indicates no palpable pulse, even with applied pressure. A 1+ signifies a faint, barely detectable pulse that may disappear with slight pressure. A 2+ denotes a slightly diminished pulse, but stronger than 1+. A 3+ represents a normal, easily detectable pulse, while a 4+ describes a strong, bounding pulse that persists even with moderate pressure. Some systems use a 0-3+ scale, where 0 is absent, 1 is decreased, 2 is normal, and 3 is bounding.
Documenting Pedal Pulse Findings
Accurate documentation of pedal pulse findings is important for tracking changes and communicating information. When charting, it is customary to specify which pulse was assessed: dorsalis pedis (DP) or posterior tibial (PT). The laterality, or which foot was assessed, is also recorded, typically using ‘R’ for right and ‘L’ for left.
The pulse strength, as determined by the chosen scale, is then noted alongside the pulse name and laterality. For example, a normal dorsalis pedis pulse on the right foot might be charted as “R DP +2” or “R DP 3+” depending on the scale used. If a pulse is absent, it would be documented as “0” or “absent.” If a pulse is difficult to palpate manually, a Doppler ultrasonic device may be used to confirm its presence, and this method should also be noted.
It is also important to note if the pulses are symmetrical between both feet. For instance, documentation might include “R DP +2, L DP +2” to indicate bilateral presence and equal strength. If a pulse is found after initial difficulty, some healthcare settings may mark the exact location on the skin with an ‘X’ to facilitate future assessments. Clear charting ensures that any changes in circulatory status are readily apparent.
Interpreting Pedal Pulse Findings
Different pedal pulse findings can suggest various aspects of lower extremity circulation. An absent or significantly diminished pulse, graded as 0 or 1+, often indicates reduced blood flow to the foot. This can be a sign of narrowed or blocked arteries, potentially due to conditions like peripheral artery disease (PAD). The dorsalis pedis pulse can be congenitally absent in approximately 10% of individuals, even with healthy circulation.
Conversely, a bounding pulse, graded as 4+, might suggest a hyperdynamic circulatory state, where blood flow is unusually forceful. While a normal, easily palpable pulse (3+ or 2+) indicates adequate blood flow, any significant change in pulse strength or symmetry warrants further attention. If a pedal pulse is absent, especially if new or accompanied by pain, numbness, or changes in skin color or temperature, report these observations to a healthcare professional for further evaluation.