The rhythmic expansion of an artery caused by the heart’s contraction is known as a pulse. This pressure wave is felt wherever an artery runs close to the skin and over a bone. Checking peripheral pulses, particularly those in the feet, provides immediate information about the circulatory health of the lower extremities. Locating and assessing these pedal pulses is a fundamental practice for evaluating lower limb blood flow. Compromised circulation in the feet and legs is a serious concern, as it indicates an inadequate supply of oxygenated blood reaching the tissues.
The Dorsalis Pedis Pulse
The dorsalis pedis (DP) pulse is one of the two primary arterial sites used to check circulation in the foot. It is located on the top, or dorsum, of the foot, where the artery continues down from the front of the ankle. The artery typically runs just lateral to the tendon of the extensor hallucis longus muscle. Asking a person to slightly extend their big toe can help make this tendon more prominent for visualization.
To palpate this pulse, the person should be seated or lying down with the foot relaxed and slightly extended. Use the pads of your index and middle fingers, avoiding the thumb, which has its own strong pulse that can be misleading. Place your fingers on the top of the foot, roughly between the first and second metatarsal bones.
Apply gentle pressure against the underlying tarsal bones. Pressing too hard can compress the artery and obliterate a weak pulse. If the pulse is not immediately felt, slowly move the fingers side-to-side or up and down in the general area, maintaining light contact.
Locating the DP pulse can sometimes be challenging because it is naturally absent in about 10% of the healthy population due to anatomical variations. In these cases, the blood supply is maintained by other foot arteries.
The Posterior Tibial Pulse
The posterior tibial (PT) pulse offers a second, independent check of blood flow to the foot and is located on the inner side of the ankle. The artery runs in a groove between two landmarks: the medial malleolus (the prominent bony bump on the inner ankle) and the Achilles tendon.
To find this pulse, the foot should be relaxed, and you should access the area behind the medial malleolus. Place the pads of your index and middle fingers just behind and slightly below this ankle bone. The artery lies deep, requiring the fingers to press the vessel gently against the tibia, the main shin bone.
Gentle to moderate pressure is necessary to compress the artery against the bone, but avoid excessive force to prevent the pulse from disappearing. The pulse is typically felt approximately one finger’s breadth below and behind the medial malleolus. Checking both the DP and PT pulses provides a comprehensive view of arterial perfusion.
What Pulse Strength and Rate Reveal
Once a pedal pulse is located, its strength and rate are assessed to gain insight into cardiovascular health and localized circulation. Pulse strength, or force, is often graded on a four-point scale to standardize findings:
- 0: Absent or not palpable.
- 1+: Weak, diminished, or thready pulse that is easily extinguished by slight pressure.
- 2+: Normal or strong, requiring moderate pressure to obliterate.
- 3+ or 4+: Strong or bounding pulse that is forceful against the fingertips and cannot be easily compressed.
A diminished or absent pulse is a significant finding that suggests arterial insufficiency. This reduced blood flow is caused by a narrowing or blockage in the artery, potentially due to Peripheral Artery Disease. This lack of blood flow threatens the health of the tissues in the foot and requires further medical evaluation.
Conversely, a bounding pulse reflects a high-volume flow and may be associated with conditions like fluid overload or high blood pressure. It could also be a temporary effect of recent physical exertion.
Beyond strength, the pedal pulse is used to determine the heart rate by counting the number of beats felt over a timed period. If the rhythm is regular, counting the beats for 30 seconds and multiplying by two provides the heart rate in beats per minute (bpm).
For adults, a normal resting heart rate typically falls between 60 and 100 bpm. A resting rate below 60 bpm (bradycardia) can be normal for highly conditioned athletes, but otherwise may signal an underlying health issue. A resting rate consistently above 100 bpm (tachycardia) may also indicate a need for medical attention.