Pedal Pulses and Plantar/Dorsi Flexion

Turd Ferguson · Jun 3, 2011

It is possible, and pretty common to not feel pedal pulses by palpation.

nurseprnRN, BSN, RN · Jun 3, 2011

let's review. ankle motion relies on what muscles and nerves? (http://www.upstate.edu/cdb/education/grossanat/limbs9.shtml). what are we trying to assess when we ask the patient to plantarflex and dorsiflex a foot?

pedal pulses (by which we mean, dorsalis pedis pulses, an artery best palpated at the top of the foot) are arterial phenomena. what are we assessing when we palpate that pulse point? are there other indicators we might use to assess that?

while it is certainly true that if you had zero arterial circulation south of, say, the popliteal space you probably wouldn't be able to move your foot up and down, i don't think you'd use ankle movement to inform you about arterial competence.

finally, many, many people have anatomy which makes feeling a dorsalis pedis pulse difficult to impossible, even though they have perfectly adequate arterial flow to their feet.

so, in answer to your question: no. this is why you have to understand why you make certain assessments and why you should care about your findings, not just how to do them.

BaltimoreHon, BSN, RN · Jun 3, 2011

You could always use a doppler.

AgentBeast, BSN, RN · Jun 3, 2011

You could always use a doppler.

DING DING DING We have a winner!!

If you can't palpate either the dorsalis pedis or the posterior tibial the first thing you should do is go and grab a doppler. Provided one is available. Never assume anything.

nurseprnRN, BSN, RN · Jun 3, 2011

i'm thinking it's less necessary to doppler an actual artery (in most clinical circumstances, barring other problems not mentioned here) than to know other ways of assessing arterial sufficiency. this is, after all, the point, :lol2: . i think that sometimes people are so enamored of technology that they forget the physiological point of why we assess things. this question epitomizes that.

on to other ways to look at this:

foot is warm? good indication.

nails are pretty normal, skin is ok, and hair distribution is normal? tells you, generally, that feet are getting enough nutrients and oxygen.

capillary fill is brisk? this means, after you compress the ends of each of the toes, they blanch (are white) and then pink up nicely within three seconds (one-and-two-and-three-and, and shorter time is better). tells you the blood flow allllll the way to the end (the capillary bed) is good.

i got the impression that the op (or someone who asked her) wondered if there were a q&d (quick and dirty) shortcut to assessing blood flow by just having the patient flex a foot. maybe she wasn't. but as an answer to that question: nope. :eek:

psu_213, BSN, RN · Jun 3, 2011

i'm thinking it's less necessary to doppler an actual artery (in most clinical circumstances, barring other problems not mentioned here) than to know other ways of assessing arterial sufficiency. this is, after all, the point, . i think that sometimes people are so enamored of technology that they forget the physiological point of why we assess things. this question epitomizes that.
on to other ways to look at this:
foot is warm? good indication.
nails are pretty normal, skin is ok, and hair distribution is normal? tells you, generally, that feet are getting enough nutrients and oxygen.
capillary fill is brisk? this means, after you compress the ends of each of the toes, they blanch (are white) and then pink up nicely within three seconds (one-and-two-and-three-and, and shorter time is better). tells you the blood flow allllll the way to the end (the capillary bed) is good.
i got the impression that the op (or someone who asked her) wondered if there were a q&d (quick and dirty) shortcut to assessing blood flow by just having the patient flex a foot. maybe she wasn't. but as an answer to that question: nope.

in a standard assessment on a pt without known arterial problems in their legs, i would agree with you. however, on a pt who has just had some sort of a procedure involving the arteries of the legs (for example, angioplasy of a leg artery, cardiac cath where they went through the femoral artery, etc.) pulses need to be appreciated. i can think of a specific instance where a vascular surgeon wrote an order for hourly charting of the strength/character of the pulses. this was not too long after another pt. of this surgeon did not have any pulses checks charted for the entire night shift. and no, mere flexion of the foot is not enough.

SNIXRN · Jun 4, 2011

i'm thinking it's less necessary to doppler an actual artery

if you can't feel a pulse, you better doppler.

i work on a ortho/urology floor and even if the patient has good cap refill, warm feet, etc.... i still doppler.