The dorsalis pedis (DP) pulse is found on the upper surface of the foot, known as the dorsum. Checking peripheral pulses like the DP is a fundamental method used to assess blood circulation, particularly in the extremities farthest from the heart. This simple, non-invasive assessment helps determine if blood flow is reaching the lower limbs effectively. Accurately locating and checking this pulse provides immediate insight into a person’s vascular health.
Why Assessing the Foot Pulse is Important
The dorsalis pedis pulse indicates peripheral blood flow in the foot. Checking the DP pulse is a routine part of a physical examination, especially for individuals with compromised circulation. Its patency, or openness, confirms that a major artery supplying the foot is functioning.
This assessment is relevant for those with conditions like diabetes or peripheral artery disease (PAD). A clear DP pulse suggests adequate arterial supply, which is necessary for tissue health and healing. In cases of trauma, checking the DP pulse quickly helps determine if circulation to the foot has been maintained or compromised, as a change in strength can signal a significant vascular event.
Locating the Dorsalis Pedis Artery
Proper patient positioning is necessary for locating the dorsalis pedis artery. The foot should be relaxed, ideally in a slightly extended or neutral position, to prevent muscle tension from obscuring the pulse. Identifying key anatomical landmarks on the dorsum of the foot helps pinpoint the artery’s location.
The easiest landmark is the extensor hallucis longus tendon, which controls the upward movement of the big toe. Asking the person to slightly lift their big toe makes this tendon stand out prominently. The dorsalis pedis artery typically runs just lateral, or to the outside, of this prominent tendon.
A more precise bony landmark is the dorsal-most prominence of the navicular bone in the midfoot. The artery is commonly located about 1 to 1.5 centimeters distal to this bony point, often in the groove between the first and second metatarsal bones. The dorsalis pedis artery is congenitally absent or difficult to palpate in about 10% of healthy individuals. Therefore, an absent pulse does not automatically indicate a blockage and may require checking the posterior tibial pulse instead.
Step-by-Step Palpation Technique
Palpation requires a gentle and focused approach. Use the pads of your index and middle fingers, avoiding the thumb because its own strong pulse can be confused with the person’s. Position your two fingers transversely across the identified area, just lateral to the extensor hallucis longus tendon.
Begin with very light pressure, as the dorsalis pedis artery is superficial, and excessive force can compress it, making the pulse undetectable. If you do not feel a pulse immediately, gradually increase the pressure slightly or move your fingers in small, circular motions. Once located, you will feel a slight, rhythmic tapping sensation beneath your fingertips.
To determine the rate, count the beats over 30 seconds and multiply by two to get the beats per minute. If the pulse feels irregular, or if this is the first check, counting for a full 60 seconds is the most accurate method. Comparing the strength and rate of the pulse in one foot to the other is also necessary for a full assessment.
Interpreting the Pulse Findings
After locating the pulse, grade its strength using a standardized scale ranging from 0 to 4+. A grade of 0 indicates an absent pulse that cannot be felt. A grade of 1+ represents a faint or diminished pulse, detectable but weaker than expected.
A grade of 2+ is considered a normal finding, signifying a healthy, easily palpable pulse. The highest grades include 3+, a strong pulse, and 4+, which is described as a bounding pulse that is unusually forceful.
An absent or significantly diminished pulse (0 or 1+) may suggest arterial insufficiency or a blockage impeding blood flow to the foot. Conversely, a bounding pulse (4+) can indicate conditions like fluid overload or certain types of heart valve issues.