Checking pulses in the feet, known as pedal pulses, is a fundamental method for monitoring the blood flow and overall circulatory health of the lower extremities. These pulses are the rhythmic waves of blood pushing against the arterial walls, reflecting the heart’s pumping action. Assessing them offers immediate, non-invasive insight into whether oxygenated blood is successfully reaching the tissues of the foot. This assessment is particularly important in situations involving trauma, existing conditions like diabetes, or any complaints of numbness or tingling in the legs. A clear, strong pulse generally indicates healthy circulation, while a weak or absent pulse can signal a potential blockage or impairment in the vascular system.
The Dorsalis Pedis Pulse Location
Locating the pulse on the top of the foot requires a light, focused touch, often with the index and middle fingertips. The person should be in a relaxed position, typically lying on their back, allowing the ankle to remain loose and slightly extended. The dorsalis pedis artery runs across the dorsal aspect of the foot, making it generally accessible to palpation. A precise anatomical guide for finding this pulse is to start on the midline of the foot and move slightly lateral to the tendon that extends the big toe. This pulse is commonly felt in the space between the first and second metatarsal bones. Applying too much pressure can flatten the artery against the bone and make the pulse impossible to feel, so a gentle yet firm press is recommended. If the pulse is difficult to find, up to 10% of healthy individuals may have a naturally absent dorsalis pedis pulse due to normal anatomical variation.
The Posterior Tibial Pulse Location
The second major pulse point in the foot provides a necessary check, especially when the dorsalis pedis pulse is not easily found. This pulse is located along the posterior tibial artery, which supplies blood to the sole and deeper tissues of the foot. To locate it, an examiner must first identify the medial malleolus, the prominent bony bump on the inner side of the ankle. The artery runs in a small groove situated just behind and slightly below the curve of this medial malleolus. The technique involves curling the examining fingers around the ankle and pressing gently into the soft tissue within the space between the bone and the Achilles tendon. Finding both the dorsalis pedis and posterior tibial pulses on the same foot provides the most comprehensive picture of lower extremity circulation.
Assessing Pulse Quality and Rate
Once a pulse is successfully located, the next step is to evaluate its characteristics, specifically its rate, rhythm, and intensity. Determining the rate involves counting the number of pulsations felt over a specific time period. Counting the beats for a full 60 seconds provides the most accurate measure, though counting for 30 seconds and multiplying by two is often used when the rhythm is regular. The rhythm is categorized as either regular, meaning the time between beats is consistent, or irregular, where the spacing between beats varies. Assessing the intensity provides context regarding the strength of the blood flow and is typically graded on a scale for standardized documentation.
Pulse Intensity Grading
- A grade of 0 signifies an absent pulse, meaning no pulsation is felt despite thorough effort.
- A grade of +1 indicates a weak or thready pulse, which is barely palpable and easily obliterated with slight pressure.
- The normal finding is a +2 grade, describing a pulse that is easily palpable and of moderate intensity.
- A pulse graded as +3 is considered bounding, meaning it is abnormally strong and forceful, which can sometimes indicate a different set of circulatory dynamics.