Int J Anat Res 2013, 02:88-92. ISSN 2321-4287

Orginal Article

AN ANATOMICAL STUDY ON DORSALIS PEDIS ARTERYM.S.Rajeshwari1, B.N.Roshankumar2, Vijayakumar3.

ABSTRACT

Address for Correspondence: Dr. M.S.Rajeshwari, Associate Professor of Anatomy , BangaloreMedical College and Research Institute, Bangalore, India. E-Mail: rajeshwari.roshan8@gmail.com

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1Associate Professor of Anatomy , Bangalore Medical College and Research Institute, Bangalore.2Professor and HOD of Orthopaedics, RajaRajeshwari Medical College, Bangalore, India.3Post Graduate, Department of Anatomy, Bangalore Medical College and Research Institute, Bangalore, India.

INTRODUCTION

International Journal of Anatomy and Research,Int J Anat Res 2013, Vol 1(2):88-92. ISSN 2321- 4287

Received: 11 Aug 2013Peer Review: 11 Aug 2013 Published (O):12 Sep 2013Accepted: 08 Sep 2013 Published (P):30 Sep 2013

International Journal of Anatomy and ResearchISSN 2321-4287

www.ijmhr.org/ijar.htm

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Background:The study of Dorsalis pedis artery and variations in its branching pattern has been reportedsporadically. The purpose of this study was to evaluate the arterial supply on the dorsum of the foot.Materials and Methods: The study was carried out on forty two dissected limbs of unknown sex and age fromthe department of Anatomy,BMCRI,Bangalore. Results and Discussion:The incidence of classical text bookdescription was found to be very less in the present study. In 16.67% of cases the arcuate artery was completelyabsent, which was compensated by two large lateral tarsal arteries that provided the dorsal metatarsal arteries.In 9.52% of cases the dorsalis pedis artery was absent. Conclusion:The findings suggest that the lateral aspectof the dorsum of the foot has a poor nourishment.KEYWORDS: Dorsalis Pedis Artery; Vascular Anatomy; Flap Reconstruction.

The main function of the foot is to support thebody during locomotion and quiet standing. Theevolved human foot is designed in such a waythat it is more resilient, can adapt to both evenand uneven surfaces. The foot is more prone forinjuries in day to day life like diabetic foot,peripheral arterial disease, industrial hazards,etc., where a need may arise for a vascularsurgery for amputation. A detailed knowledgeabout the vessels of the foot and its variationsis needed in such situations. The arterial feedersfor the foot are derived from dorsalis pedis arteryand its branches on the dorsal aspect, and bythe medial and lateral plantar artery and theirbranches on the plantar aspect.The dorsalis pedis artery is the continuation ofanterior tibial artery. It begins on the anterior

surface of the ankle joint, and runs with the deepperoneal nerve, deep to the inferior extensorretinaculum and extensor hallucis brevis, to theproximal end of first intermetatarsal space. Hereit divides into arcuate artery and first dorsalmetatarsal artery. It gives medial and lateraltarsal branches to the tarsal bones and extensordigitorum brevis. The arcuate artery runslaterally across the bases of the metatarsals deepto the extensor tendons, and gives a dorsalmetatarsal artery to each of the otherintermetatarsal spaces. Each of thesecommunicates through the proximal end of theintermetatarsal space with the perforatingbranches of plantar arch. Each dorsal metatarsalartery runs forwards on the corresponding dorsalinterosseous muscle and forms the dorsal digitalartery in each of adjacent toes [1].

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MATERIALS AND METHODS

OBSERVATIONS & RESULTS

Forty two dissected lower limbs of unknown sexand age were obtained in a span of two yearsfrom the Department of Anatomy, BangaloreMedical College and Research Institute,Bangalore. Karnataka, India. The limbs weredissected lower down from the level of the anklejoint on the dorsal aspect till the level of the webspace, the long tendons were severed, anteriortibial artey was identified and traced down,interestingly different varieties in the origin ofdorsalis pedis artery, its branching pattern andthe course were noted.

1. Normal course and branches of Dorsalispedis artery:In the present study in 54.76% of cases theanterior tibial artery continued as the dorsalispedis artery and gave the lateral tarsal artery,medial tarsal artery, arcuate artery and firstdorsal metatarsal artery and continued as thedeep plantar artery after piercing the first dorsalinterosseous muscle. (Fig: 1)

Fig-1: Normal course and branching pattern of Dorsalispedis artery.2. Absence of Dorsalis pedis artery:The anterior tibial artery bifurcated into twoterminal branches as medial and lateral tarsalarteries in front of the ankle joint; the caliber ofthe artery was very small. In this, the dorsalispedis artery and the first dorsal metatarsalarteries were completely absent. The secondand third dorsal metatarsal arteries came from

the lateral tarsal artery and the fourth dorsalmetatarsal artery was absent. (Fig: 2)

Fig-2: Absence of dorsalis pedis artery.

Fig-3: Absence of arcuate artery and variation in thenumber of lateral tarsal arteries.

3. Absence of arcuate artery and variation inthe number of lateral tarsal arteries:Dorsalis pedis artery began as the continuationof anterior tibial artery and coursed to theposterior end of the first interosseous space, inits course it provided from its lateral aspect threelateral branches called as proximal, intermediateand distal lateral tarsal arteries. The dorsalispedis artery before piercing the first dorsalinterosseous muscle provided the first dorsalmetatarsal artery, the arcuate artery beingcompletely absent. The distal lateral tarsal arterycontinued as the second dorsal metatarsal artery

M.S.Rajeshwari, B.N.Roshankumar, V ijayakumar. An Anatomical Study on Dorsalis Pedis Artery.

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and the intermediate lateral tarsal arterycontinued as the third dorsal metatarsal artery,which also provided a small twig to the fourthintermetatarsal space as the fourth dorsalmetatarsal artery, the proximal lateral tarsalbranch anastomosed with the lateral malleolarbranch of anterior tibial artery. The medial tarsalartery arose opposite to the proximal lateraltarsal artery as a single branch. (Fig: 3)4. Absence of dorsalis pedis artery withvariation in the origin of dorsal metatarsalarteries:The anterior tibial artery divided into medial andlateral tarsal arteries in front of the ankle joint.The lateral tarsal artery being larger in sizeprovided three branches, the first branch aroseas a common trunk which later divided into twobranches the medial and lateral branch, themedial branch continued as first dorsalmetatarsal artery with an oblique course toreach the posterior end of first intermetatarsalspace, the lateral branch continued as thesecond dorsal metatarsal artery. The secondbranch from the lateral tarsal artery reached thethird intermetatarsal space and continued as thethird dorsal metatarsal artery and the thirdbranch from the lateral tarsal artery reached thefourth intermetatarsal space to continue as thefourth dorsal metatarsal artery(Fig:4).

Fig-4: Absence of dorsalis pedis artery with variationin the origin of dorsal metatarsal arteries.

5. Variation in the origin of second dorsalmetatarsal artery:The anterior tibial artery continued as thedorsalis pedis artery in front of the ankle joint,itprovided a lateral tarsal artery which divided intotwo branches to continue as third and fourthdorsal metatarsal artery. The dorsalis pedisartery in its course provided medial tarsal artery,first dorsal metatarsal artery and second dorsalmetatarsal artery. (Fig: 5)

Fig-5: Variation in the origin of second dorsal metatar-sal artery.

Fig 6: Arcuate artery replaced by U shaped loop.

6. Arcuate artery replaced by U shaped loop:Dorsalis pedis artery in the course providedproximal lateral tarsal artery, medial tarsal artery,distal lateral tarsal artery; then it reached thefirst intermetatarsal space and gave the first

M.S.Rajeshwari, B.N.Roshankumar, V ijayakumar. An Anatomical Study on Dorsalis Pedis Artery.

Int J Anat Res 2013, 02:88-92. ISSN 2321-4287

dorsal metatarsal artery; the proximal and distallateral tarsal arteries united together to form an‘U’ shaped loop. From the loop it gave origin tothe second ,third and fourth dorsal metatarsalarteries.(Fig: 6)DISCUSSIONThe arterial supply to the developing lower limbstarts as a capillary plexus off the dorsal side ofthe umbilical artery and internal iliac artery. Theartery formed from this plexus is the axial arteryand is located in the dorsal aspect of the leg. Theaxial artery terminates by passing through thesinus tarsi and forming a plantar capillarynetwork. The femoral artery forms from theexternal iliac artery, descends along the ventralaspect of the thigh and terminates on thedorsum of the foot. During its development thefemoral artery communicates with the axisartery distally. At the proximal border of thepopliteus muscle it provides primitive posteriortibial and primitive peroneal arteries which rundistally to gain the sole of foot. At the distalborder of popliteus the axis artery gives off theperforating branch and passes ventrally betweenthe tibia and fibula and then courses to thedorsum of foot, forming the anterior tibial andarteria dorsalis pedis. The proximal parts of theprimitive posterior tibial and peroneal arteriesfuse, but remain separate distally. Graduallybetween the end of the embryonic period andbirth the axial artery degenerates and persistsas the popliteal and peroneal areries [1].Dorsalis pedis artery is the main source of arteryto the dorsum of the foot. In its course itprovides the medial tarsal artery, lateral tarsalartery, first dorsal metatarsal artery, arcuateartery and deep plantar artery which enters thesole after passing between the two heads of firstdorsal interosseous muscle and takes part in theformation of the plantar arch [2].In 54.76%of cases the anterior tibial arterycontinued as the dorsalis pedis artery and hadits course and branches as the classical text bookdescription. In 9.52%the anterior tibial arterybifurcated just below the level of ankle joint asmedial and lateral tarsal artery, the dorsalis pedisartery being completely absent. Yamada et al[3] in their study reported absence of dorsalispedis artery in 6.7% of cases and the dorsal

metatarsal arteries were supplied by the plantararteries.In 16.67% of cases dorsalis pedis artery failed toprovide the arcuate branch. Yamada et al in hisstudy found 33% of absence of arcuate artery,Dilandro et al [4] reported 83.3% of absentarcuate artery suggesting that the arcuate arteryis not the primary blood supply to dorsalmetatarsal artery as is commonly described andthe lateral tarsal artery provided 2nd, 3rd and 4th

dorsal metatarsal artery more frequently in47.2% than the arcuate artery. In our study, outof 16.67% of dissected specimens in 2.38% ofcases this was compensated by three lateraltarsal arteries which are the branches of dorsalispedis artery called as the proximal, intermediateand distal lateral tarsal artery and continued overthe metatarsals as the 2nd, 3rd and 4th dorsalmetatarsal artery. In the remaining 14.29% ofcases the lateral tarsal arteries were two innumber, the proximal and distal providing thedorsal metatarsal arteries. The caliber of 3rd and4th dorsal metatarsal arteries was very small.Yamada et al reported in their study the presenceof proximal and distal lateral tarsal artery whichgave the dorsal metatarsal arteries. This wassimilar to the study done by Saeed et al [5] andHamada et al [6] who opined that lateral tarsalartery was always double in all the specimensthey studied, but the intermediate branch foundin our study has not been reported in anyliterature.In14.29% of cases the second dorsal metatarsalartery originated from the dorsalis pedis artery,which is not infrequent. Mitra [7] in his study inone case found this pattern during routinedissection.Lee et al [8] in their study reported the origin offirst dorsal metatarsal artery from the dorsalispedis artery in 90.6% of cases and in 9.4% ofcases it came from the lateral tarsal artery. Inthe present study in one case i.e. in 2.38%, thefirst dorsal metatarsal artery arose from thelateral tarsal artery which is similar to ourstudy.Gabrielli & Olave et al [9] in their studywhich included fifty feet found that first dorsalmetatarsal artery originated from dorsalis pedisartery in 86%, from plantar network in 10% andmixed in 4%.

M.S.Rajeshwari, B.N.Roshankumar, V ijayakumar. An Anatomical Study on Dorsalis Pedis Artery.

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How to cite this article:M.S.Rajeshwari, B.N.Roshankumar, Vijayakumar.An Anatomical Study on Dorsalis pedis artery. IntJ Anat Res,2013;02:88-92.

CONCLUSION

The second, third and fourth dorsal metatarsalarteries arose from the arcuate artery in 10%,6% and 10% respectively. In their study theyreported the absence of arcuate artery, thelateral tarsal artery provided the dorsalmetatarsal arteries which holds good with ourstudy.In 2.38%the arcuate artery was replaced by a U-shaped loop formed by the union of proximal anddistal lateral tarsal artery which provided thesecond and third dorsal metatarsal arteries andthe fourth dorsal metatarsal artery wascompletely absent.This variety has not been reported in theliterature.

REFERENCES

Pulsations of dorsalis pedis artery at the 1st

intermetatarsal space is an indicator of itspatency, which is usually obliterated or evenabsent in ThromboAngitisObliterans. Theabsence of arterial pulse in the firstintermetatarsal space does not imply that thereis ThromboAngitisObliterans disease, as dorsalispedis artery is frequently absent in manyinstances. Arcuate artery is not the principalartery which gives out dorsal metatarsal arteries,as in majority of the cases the dorsal metatarsalarteries are derived from the lateral tarsal arteryin the absence of arcuate artery.The caliber of the dorsal metatarsal artery in thethird and fourth spaces is very small or they maybe completely absent. It was however observedthat lateral 1/3 rd of the dorsum of the foot hasa very poor blood flow, hence these areas eithernot supplied at all or with insufficient bloodsupply are frequently the sites of non-healingulcers especially in the diabetic foot and alsomore prone for gangrene. The grafts done inthese areas may not be successful. Hence athorough knowledge of the arterial patterndepicted by an arteriography is important,before attempting any surgical procedures.

3. YamadaT, Gloviczk.P, BowerT.C, Naesseus J.M,Carmichand S.W, Variations of the arterial anatomy offoot; Am.J.Surg 1993,Aug :166(2)130-5.4. Di landro.A.C,Li lja.E.C ,LeporF.L,V iscovichJ.B,CampiarN, DattaUK, Signorile.J. The prevalence of thearcuate artery a cadaveric study ; J.Am PodiatricMed.Assoc;2001Jun91(6)300-5.5. Ebrahim M.El Saeed, Amal Abd El-monisif Madiha A.El-Sayed, Nancy M.Aly, Naser A. Gezlan. Anatomicalstudy of dorsalis pedis artery and its surgical importancein Reconstr.surg: Alexandria Journal of medicine2008;44(2).557-571.6. HamadaN,IkutaY,IkedaA. Arteriographic study of thearterial supply of the foot.Surgical and RadiologicalAnatomy.1993;15:187-92.7. Nilesh.k. Mitra, Omar A Habbal ,Abdul ghaffar H El-Hag,Nasser A Al-Hashmi. Bilateral Absence of the ArcuateArtery on the Dorsum of the Foot. Sultan QaboosUniv.Med.Journal;2007 Aug:7(2):153-55.8. Lee.J.H,DauberW,Anatomical study of Dorsalis pedisartery and first dorsal metatarsalartery,AnnPlast.Surg;1997;Jan38(1);50-5.9. Gabrielli.C.Olave E. Origins of dorsal metatarsalarteries in Humans, scand .J.Plast Reconstr.surg.Handsurg.2002;36(4)221-5.

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edition;1326-27.2. Henry Gray. Development of arteries of Lower limb,Gray’s text book of Anatomy, The Anatomical basis ofMedicine and Surgery, Churchill living stone. London.1995, 38th edition. pp 320.