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I was challenged by a 4th year DPM student, who claims she learned in her anatomy class, that 90 something percent of the arterial circulation to the foot of a healthy patient is supplied by the PT. I tend to disagree since I think, that it is common finding that the DP(dorsalis pedis) supplies more blood to the foot than the PT. I couldn't find anything on the subject when I tried to google it. Can anyone help me with this?
7. Identify the vascular supply of the foot and give the regions supplied by each. (W&B 623-632)
The dorsalis pedis, the continuation of the anterior tibial artery, has many branches, and eventually becomes the deep plantar artery. This artery dives to the sole of the foot (between the 2 heads of the 1st dorsal interosseous muscle, between the 1st and 2nd toes). It unites with the lateral plantar artery to form the plantar arterial arch.
The posterior tibial artery divides into the medial and lateral plantar arteries. The medial plantar artery runs in the groove between the medial and central compartments. It supplies the medial compartment, including the muscles of the great toe. It also gives off most of the plantar digital branches. The lateral plantar artery supplies the lateral compartment, including the muscles of the little toe. Both the lateral and medial plantar arteries supply the central compartment.
The arterial supply of 100 human cadaver feet (87 cadavers) was investigated by stereoscopic arteriography and was compared phylogenetically to that of the macaque foot. The deep plantar arch was always well developed and complete, whereas the superficial plantar arch was usually slender and incomplete. The first proximal perforating artery arising from the dorsalis pedis artery formed the main component of the deep plantar arch in 82% of the feet. The second proximal perforating artery arising from the dorsal rete contributed to the deep plantar arch in 43% of the feet, and formed most of the arch in one foot. The dorsal rete was classified into four groups of variants based on the arterial source of the second dorsal metatarsal artery. These were the arcuate artery (25%), distal lateral tarsal artery (12%), proximal lateral tarsal artery (6%), and nondorsal rete (57%) variants. In the first intermetatarsal space, the dorsal and plantar metatarsal arteries shared a common trunk in 54% of the feet, but this did not occur in the other intermetatarsal spaces. The second dorsal metatarsal artery arose from the dorsal rete in 43% of the feet, and this artery was quite large, sometimes being the largest of all the dorsal and plantar metatarsal arteries. Variations of the arterial supply found in humans sometimes resembled the typical pattern found in the macaque.
Google Scholar is also a valuable resource although many publications require payment to view.
Suffering a fondness for odd things.
“ Though the mills of God grind slowly;
Yet they grind exceeding small;
Though with patience he stands waiting,
With exactness grinds he all. ”
I'd be interested in the students (or her teacher's) source of information.
On a practical level, I don't think many of us regard an absent DP pulse as clinically important if there are no other signs of PVD (unlike an absent PT), in fact an absent Dorsalis Pedis is an anatomical variant.
On the other hand, I would be curious as to why they are teaching physiology in anatomy class.
Fellow American College of Foot & Ankle Surgeons
Board Certified Foot & Ankle Surgery, ABPS
Adjunct Professor OCPM
Green Bay, Wisconsin, USA
Thank you all for your replies, DrSarbes, you're saying that if PT is absent the patient has a bigger risk of having PVD? while if the DP is absent since it's a normal variant in some cases is not an indication of PVD?