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.

Figure 1

Showing bilateral anomalous origin of dorsalis pedis artery from enlarged perforating branch of peroneal artery and absence of arcuate artery in the right limb and dorsal metatarsal arteries arising from dorsalis pedis artery. TA-Tibialis anterior, EHL-Extensor hallucis longus, EDL-Extensor digitorum longus, PT-Peroneus tertius.

Figure 2

Showing double dorsalis pedis artery. SB-superficial branch, DB-deep branch, LTA-lateral tarsal arteries, MTA-medial tarsal artery, AA-arcuate artery.

Figure 3

Showing bilateral deviation and bifurcation of dorsalis pedis artery and extremely thin dorsalis pedis artery in right limb. DPA-Dorsalis pedis artery, LB-lateral branch, MB-medial branch.

Figure 4

Showing trifurcation of dorsalis pedis artery and entering sole in the II inter metatarsal space. FDMA-first dorsal metatarsal artery, AA-arcuate artery, continuation of DPA – continuation of dorsalis pedis artery, Deep PA-deep plantar artery, SDMA-second dorsal metatarsal artery.

Figure 5

Showing 2nd and 3rd dorsal metatarsal arteries arising directly from the dorsalis pedis artery. DMA-Dorsal metatarsal arteries.

Figure 6

Absence of arcuate artery with dorsal metatarsal arteries arising from plantar arch. FDMA-First dorsal metatarsal artery, Deep PA-Deep plantar artery.

Figure 7

Dorsal metatarsal arteries arising from plantar arch. FDMA-First dorsal metatarsal artery, DMA-Dorsal metatarsal arteries.

Figure 8

Absence of arcuate artery with 2nd dorsal metatarsal artery arising from dorsalis pedis artery, 3rd and 4th dorsal metatarsal arteries from plantar arch. SDMA-Second dorsal metatarsal artery, LTA-lateral tarsal artery.

Figure 9

Absence of arcuate artery with 2nd dorsal metatarsal artery arising from plantar arch, 3rd and 4th dorsal metatarsal arteries from lateral tarsal artery.