Variations in the origin, course and branching pattern of dorsalis pedis artery with clinical significance

Abstract

Pulsations of the dorsalis pedis artery are commonly used to evaluate the peripheral arterial diseases like thromboangiitis obliterans (TAO) or Buerger’s disease, in lower limbs. Dorsalis pedis artery is a direct extension from the anterior tibial artery and major vascular supply for the dorsum of the foot. But arterial variations in lower limbs are common due to rich distal anastomoses around the ankle joint. Absence of dorsalis pedis arterial pulse does not indicate peripheral arterial disease always as it is sometimes replaced by the enlarged perforating branch of peroneal artery, it may be absent or very thin, deviate laterally on the dorsum of foot. Aim of the present study is to observe the variations in origin, course and branching pattern of dorsalis pedis artery because of its clinical significance. During routine dissection of lower limbs for undergraduates we came across rare variations in the dorsalis pedis artery in its origin, course and branching pattern. Normal anatomic description was found in 27 limbs. In 13 specimens we noted variations, includes bilateral anomalous origin of dorsalis pedis artery, bilateral lateral deviation of dorsalis pedis artery, double dorsalis pedis artery, trifurcation of dorsalis pedis artery and absence of arcuate artery. Knowledge about the arterial variations around the ankle is important to orthopaedic, vascular surgeons and radiologists to prevent complications during surgical interventions.

Implications of Dorsalis Pedis Artery Anatomical Variants for Dorsal Midfoot Surgery

“…In contrast, our prevalence rate was lower than previously reported rates of 52%, 20 53.3%, 28 54.7%, 19 56%, 26 65.6%, 4 67.5%, 14 and 67.5%. 10 Moreover, 3 further studies have reported rates of 90%, 25 96%, 23 and 98% 21 ; however, these high rates for the standard anatomical course of the DPA are questionable because they are so far away from the findings of the majority of other researchers. Overall, their study found the arterial network of the foot to show the normal "textbook" anatomy, which is a very rare finding.…”

“…There are many reports of variations in the standard branching pattern of the DPA. 5,10,15,17,19,20,22 The Lisfranc joint, also known as the tarsometatarsal (TMT) joint, can be fused in patients with osteoarthritis or injury. Marks et al 16 and Alberta et al 1 compared the use of plates and screws for fusion of the TMT joints during loading.…”

“…There are many reports of variations in the standard branching pattern of the DPA. 5,10,15,17,19,20,22…”

Deep Peroneal Nerve: Orientation and Branching at the Ankle and Proximal Part of the Foot

“…21 In the sense of number, this artery itself can be found in double or even the increase in distal branching as atypical trifurcation. 23 Furthermore, the branching patterns on the dorsum of foot were surprisingly various as classified up to 9 types with the typical pattern at only 36.4% in prevalence. 22 All of these knowledge play an important role in reducing the risk of complications from intervention dealing with this artery or the structures nearby, eg., nerves, bones and joints.…”

“…Apart from the orientation variation of the distal part of DPA described in Table 2, there have been additional variations in terms of number, location and also its branching pattern. [21][22][23] For example, distance variation due to DPA location in relation to the tarsal navicular bone was established to provide the practical data for the midfoot surgery. 21 In the sense of number, this artery itself can be found in double or even the increase in distal branching as atypical trifurcation.…”