Unable to process the form. Check for errors and try again. Thank you for updating your details. Log In. Sign Up. Become a Gold Supporter and see no ads. Log in Sign up. Articles Cases Courses Quiz. About Recent Edits Go ad-free.
Edit article. View revision history Report problem with Article. Citation, DOI and article data. But medial tarsal was arising from the deep branch and arcuate artery from the superficial branch. This type of variation has not been reported till now in the literature. Lateral deviation and bifurcation of dorsalis pedis artery has been reported by Bailleul et al. In the present study also dorsalis pedis artery showed bifurcation just distal to ankle joint, the medial branch continued as dorsalis pedis artery after passing deep to the tendons of peroneus tertius and extensor digitorum longus and returned to the first dorsal inter metatarsal space in the distal part of the foot.
In another study by Kesavi et al. If the course of dorsalis pedis artery is oblique it may result in impaired healing in fracture of distal end of tibia, fibula and malleoli due to external or internal fixation 3. Anomalous origin of dorsalis pedis artery like this and lateral deviation of dorsalis pedis artery passing anterior to inferior tibiofibular syndesmosis may get damaged during ankle arthroscopy.
Trifurcation of dorsalis pedis artery is a rare variation not reported so far in the literature. Lateral branch was arcuate artery, medial branch was first dorsal metatarsal artery and middle one continued as dorsalis pedis artery.
After giving second dorsal metatarsal artery it entered sole as deep plantar artery in the second dorsal inter metatarsal space instead of first dorsal intermetatarsal space. This variation is also not mentioned in the literature. However, Nilesh et al. But in the present case, second dorsal metatarsal artery was arising from dorsalis pedis artery even in the presence of arcuate artery is not reported in the literature.
In the present study, we also got another not described variation, that is, in the absence of arcuate artery the 2nd 3rd and 4th dorsal metatarsal arteries were arising from dorsalis pedis artery and not from the lateral tarsal artery. According to Nilesh et al. But according to DiLandro et al. It was the lateral tarsal artery which gave dorsal metatarsal 2nd, 3rd and 4th arteries more frequently We are reporting three significant variations not reported in the literature are—in the dorsalis pedis artery origin Double dorsalis pedis and it termination branching pattern 2nd, 3rd and 4th dorsal metatarsal arteries arising from dorsalis pedis artery in the absence of arcuate artery and not from lateral tarsal artery and termination trifurcation of dorsalis pedis artery and entering the sole in the second dorsal metatarsal space instead of first dorsal metatarsal space as it is important for radiologists, vascular surgeons and reconstructive surgeons in order to prevent complications like ischemia and subsequent necrosis due to vascular trauma.
Table 1 showing compilation of the previous studies with present study. Variation in the origin course and branching pattern of lower limb arteries are accidently found during dissections of the foot. Precise knowledge of this is important for surgeons and radiologists who operate and do interventional procedures in this area. Retrograde pedal access is a viable revascularization technique for saving limb in patients with critical limb ischemia.
Revascularization is the main therapy for restoring adequate blood supply to the wound, to promote healing in diabetic foot, thus avoiding major amputations. First dorsal metatarsal artery is the most widely arterial pedicle used in toe to hand transplants.
Success of the transplant depends on the diameter of the first dorsal metatarsal artery and not the space. As variation in dorsalis pedis artery is quite common, it is essential to have a preoperative angiography for any abnormality, to prevent risks during surgical intervention.
Susan, S. Google Scholar. Tuncel, M. A case of bilateral anomalous origin for dorsalis pedis arteries anomalous dorsalis pedis arteries. Cheung, C. Variations in origin and course of the Dorsalis pedis artery: A case study. Bailleul, J. Descriptive and topographical anatomy of the dorsal artery of the foot.
CAS Google Scholar. Sabri, S. Retrograde pedal access technique for revascularization of infra inguinal arterial occlusive disease.
Article Google Scholar. Wang, L. Repair of hand defects by transfer of free tissue flaps from toes. Trauma Surg. Kalfarentzos, E. Clinical application of the dorsalis pedis free flap for reconstruction of oral cancer defects. Oral Maxillofac. Gu, Y. Vascular anatomic variations in second toe transfers. Hand Surg. MartinezVillen, G. The arterial system of the first intermetatarsal space and its influence in toe-to-hand transfer: A report of 53 long-pedicle transfers.
Heredero, S. Osteomyocutaneous peroneal artery perforator flap for reconstruction of the skull base. Pernes, J. Infrapopliteal arterial recanalization: A true advance for limb salvage in diabetics.
Diagn Interv. Christoforou, P. Dorsalis pedis artery aneurysm: A case report and review of the literature. Senior, H. The development of the arteries of the human lower extremity. Szpinda, M. An angiographic study of the anterior tibial artery in patients with aortoiliac occlusive disease. Folia Morphol. Shetty, S. Hypoplastic anterior tibial artery associated with continuation of fibular peroneal artery as dorsalis pedis artery—A case report.
Yamada, T. Variations of the arterial anatomy of the foot. Vijayalakshmi, S. Anatomical study of dorsalis pedis artery and its clinical correlations. Ali, M. Dorsalis pedis artery: Variations and clinical significance. Indian Med. Double dorsalis pedis artery—A rare case report.
Kesavi, D. Anomalous course of dorsalis pedis artery. Mitra, N. Bilateral absence of the arcuate artery on the dorsum of the foot: With anomalous origin of dorsal metatarsal arteries.
Sultan Qaboos Univ. DiLandro, A. The prevalence of the arcuate artery: A cadaveric study of 72 feet. Shane Tubbs, R. Bergman's comprehensive encyclopedia of human anatomic variation. Ebrahim, M. Anatomical study of the Dorsalis pedis artery and its surgical importance in reconstructive surgery. As the artery passes over the ankle joint, it becomes the dorsalis pedis artery.
The artery sits on the dosum top of the foot, running over the tarsal bones then down toward the plantar sole of the foot. It lies between the two tendons of the extensor digitorum longus muscle. At the plantar side of the foot, the dorsalis pedis artery branches into dorsal metatarsal arteries and ends as small dorsal digital arteries. Anatomical varations of the artery are not uncommon.
One study found nine variations in the anatomy of the artery, including the absence of the artery. The dorsalis pedis artery carries oxygenated blood to the foot. Proper blood flow is necessary for the feet to maintain proper health and mobility. Reduced blood flow can cause complications like pain, ulceration, poor wound healing, or even loss of limb.
Two muscles that lie on the dorsal top of the foot—the extensor hallucis and the extensor digitorum brevis—receive blood supply from the dorsalis pedis artery. Nerves in the foot play a role in vasoconstriction, a normal process that controls blood distribution throughout the body. Palpating the dorsalis pedis artery is done when a physician is checking for peripheral artery disease. A low or absent pulse may indicate vascular disease.
For those with type 2 diabetes , an absent dorsalis pedis pulse is a predictor of major vascular outcomes. Plaque fatty deposit buildup in the arteries can happen anywhere in the body. When fatty deposits accumulate in the arteries, and blood vessel walls become injured, they make the walls stickier.
Substances floating through your blood, like fat, proteins, and calcium then get stuck on the walls, causing the walls to grow narrower. Arteries in the lower limb are particularly prone to atherosclerosis , which can lead to decreased blood flow and cause tissue and organ damage.
Peripheral arterial disease PAD is a type of atherosclerosis that occurs in the arteries in the extremities. When these arteries become blocked, muscles in the lower legs and feet become weakened and cramp.
Type 2 diabetes is the most common reason for amputation of toes and feet in the U. Pain or discomfort in the legs, feet. Other symptoms include cold feet, discoloration of the skin, infection, and foot sores that do not heal. People who smoke, have diabetes, high blood pressure , high cholesterol , kidney disease , are obese , and over 50 are at higher risk for PAD.
People with PAD often have atherosclerosis in other parts of the body, as well. Diagnosis of PAD is made by measuring blood pressure in the lower legs and comparing it to that of the arms. A pulse volume recording PVR , which measures blood volume changes in the legs, may also be done. This test can help determine where blockages are located.
A vascular ultrasound may be done to examine blood circulation. Left untreated, PAD can lead to heart attack , stroke , renal disease, and amputation. Treatment for PAD may include lifestyle changes, such as smoking cessation , diet changes, exercise, foot and skin care, and a walking regimen.
Managing other health conditions that may be contributing to the condition is also important. Medication may also be used to treat co-existing conditions, like high blood pressure and high cholesterol. Antiplatelet medications may reduce the risk of heart attack or stroke and Pletal cilostazol may be able to improve walking distance.
When lifestyle and medication are not enough, further intervention, like angiogram with endovascular intervention or surgical bypass may be needed. Atherectomy is a procedure that uses a catheter to remove plaque from the artery. The catheter is inserted into the artery through a small hole. It is performed either in the hospital or in vascular surgeons' offices.
0コメント