AN ANATOMICAL STUDY ON DORSALIS PEDIS ARTERY Dorsalis Pedis Artery; Vascular Anatomy; Flap Reconstruction. ... anterior tibial artery. It begins on the anterior surface of the ankle

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  • 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

    88

    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].

  • Int J Anat Res 2013, 02:88-92. ISSN 2321-4287 89

    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.

  • Int J Anat Res 2013, 02:88-92. ISSN 2321-4287 90

    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 anU 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

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