The posterior tibial pulse serves as an important indicator of circulatory health, particularly in the lower extremities. Assessing this pulse provides insights into blood flow to the foot and ankle. This non-invasive assessment can offer early indications of potential vascular issues, prompting further investigation if concerns arise.
Precise Location
The posterior tibial pulse is found on the inner aspect of the ankle, behind the medial malleolus. This is the prominent bony bump on the inside of your ankle. The pulse is located in the groove between the medial malleolus and the Achilles tendon, or midway between the medial malleolus and the medial calcaneal tubercle (a bony projection on the heel).
The posterior tibial artery, which gives rise to this pulse, runs superficially. It supplies blood to the posterior compartment of the leg and the sole of the foot. While typically found in this area, anatomical variations can alter its exact position.
Technique for Detection
Positioning is important to feel for the posterior tibial pulse. The patient should be lying down or seated comfortably with the foot slightly relaxed. Remove socks and shoes to expose the ankle area. Next, locate the medial malleolus, the bony prominence on the inner side of the ankle.
Place the pads of your index and middle fingers behind and slightly below the medial malleolus. Avoid using your thumb, as it has its own pulse that could be confused with the patient’s. Apply gentle to moderate pressure against the tibia bone, aiming to feel for a tapping or throbbing sensation.
Pressing too hard can compress the artery, making the pulse undetectable. If difficulty is encountered, trying slight dorsiflexion of the foot or gently repositioning the fingers can help. Comparing the pulse on both ankles provides a symmetrical assessment.
Understanding Pulse Characteristics and When to Seek Medical Attention
A normal posterior tibial pulse feels strong and regular, indicating healthy blood flow to the foot. Healthcare providers often grade pulse strength, with a 2+ representing a normal pulse. The rhythm should also be consistent, without skips or irregularities.
Difficulty finding the posterior tibial pulse can occur for several reasons. This includes technique errors, such as applying too much pressure or incorrect finger placement. Anatomical variations mean the pulse may be naturally absent in a small percentage of the population, estimated around 1% to 5%. Conditions like edema (swelling), obesity, or cold temperatures can also make the pulse harder to detect.
If the posterior tibial pulse is consistently weak, irregular, or absent, it may signal underlying health concerns. A diminished or absent pulse indicates reduced blood flow to the feet, potentially due to narrowed or blocked arteries. This could be a sign of peripheral artery disease (PAD), diabetes-related circulation issues, or other vascular conditions. Seek professional medical attention if the pulse cannot be found, or if there are other symptoms of poor circulation such as pain, numbness, skin color changes, or non-healing wounds in the lower extremities.