Pulses

Pulses:

Femoral:
• just below inguinal ligament – midway between anterior superior iliac spine and symphysis pubis
• usually need firm deep pressure

Popliteal:
• bend knee to 10°, firm pressure in popliteal space with pads of fingers
• often difficult to find

Posterior tibial:
• behind medial malleolus
• difficult to palpate of oedema present

Dorsalis pedis:
• on dorsum of foot, just lateral to extensor hallucis longus
• Dorsalis pedis is anatomically absent in up to 18% of population.

Others:
• may also be possible to palpate anterior tibial artery and perforating branch of the peroneal artery.

Amplitude is usually rated as:
+1/4 = weak
+2/4 = normal
+3/4 = full
+4/4 = bounding

Reliability of pulse palpation:
Misdiagnosis found to be unacceptably high among vascular surgeons, but higher among vascular laboratory technicians . The results may be explained b the more hurried environment that vascular surgeons work in – this may emphasise the importance of palpating pulses in a non hurried relaxed environment.
Foot pulse palpation in those with arterial disease has substantial observer error .

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