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Department of Podiatry - Vascular Assessment Pulse ExaminationPalpation of the dorsalis pedis, posterior tibial, popliteal, aortic, radial and femoral arteries are a vital, extremely important element of the physical examination of the lower extremity. Pulse examination can provide the astute clinician an accurate assessment of arterial circulation. Pulse examination should be carried out in the same conditions as the ABPI, the patient being supine and resting for at least five minutes. It is of importance to note features such as:
Within the literature there are a multitude of various methods used to grade pulse examination, unfortunately there is no standard format recognized. In light of this we have decided to adopt the method described by Kidawa (1992):
Whilst the significance of the pulse examination should not be underestimated it must be observed that there is concern over the inter-observer variation and normal anatomical arterial variations in the foot. According to McGee (Mc Gee, 1998), when deciding whether a pulse is present or absent, clinicians show fair to almost perfect agreement, although attempts to distinguish between normal and reduced pulses cause considerable dissention. It has been noted in large studies of healthy individuals, the dorsalis pedis, posterior tibial and femoral pulses are not palpable 8.1%, 2.9% and 0.0% of the time respectively (McGee, 1998). Absence of both of the pedal pulses has been found to correlate well with, and be a powerful predictor of the presence of PAD. The patient’s medical history can reveal multiple factors that can serve to increase or decrease pulse amplitude, the rate and rhythm of the pulse. Some risk factors to look out for are detailed earlier in the assessment format. It is therefore a good practice to ausculate the larger vessels in order to detect a bruit, which is often associated with an aneurysm, arterio-venous fistula, or a large stenosis. |
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