Doppler examination of pedal pulses is generally accepted as more accurate than pulse palpation.5 As such, Doppler ultrasound examination typically demonstrates increased sensitivity with an absent signal over the presumed location of the dorsalis pedis artery in only 1.9% of patients.1Discrepancy of pedal pulse detection and with regards to its accuracy persists among clinicians. Since the location of the posterior tibial artery is well delineated by a bony landmark, it is more reliably detected by Doppler ultrasonography. One study demonstrated increased interinvestigator agreement among 78% of posterior tibial pulses versus only 58% of the dorsalis pedis pulses when identified by Doppler ultrasonography.9 Paradoxically, the posterior tibial artery is believed to be more difficult to palpate in comparison with the dorsalis pedis artery.10 This is felt to be secondary to the deeper location of the posterior tibial artery especially when compounded by ankle swelling.9 In contrast, the dorsalis pedis arterial pulse is felt to be more accessible to finger palpation since it lies in the immediate subcutaneous tissue on the dorsum of the foot.8Pedal pulse detection remains a mainstay for lower extremity perfusion assessment; thus, establishing exact pulse detection techniques are necessary.
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