Palpae Potami: a Novel Method of Palpating Dorsalis Pedis Artery
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ORIGINAL ARTICLE
Palpae Potami: a Novel Method of Palpating Dorsalis Pedis Artery Aravind Ravichandran 1 & Aparnaa Balasubramanian 2 Received: 24 February 2019 / Accepted: 24 February 2020 # Association of Surgeons of India 2020
Abstract The peripheral pulse examination of the foot is the preliminary yet important step in diagnosing peripheral vascular diseases. It has been reported that locating the dorsalis pedis pulse is difficult with existing variability among examiners when compared with other distal foot pulse examination. Ill-defined landmark and a high rate of aberrant course of the artery have been attributed for its difficulty (Mowlavi et al. Postgrad Med J 78(926):746–747, 2002; Vijayalakshmi et al. J Clin Diagn Res 5(2):287–290, 2011). Here, we present a new method for examination of dorsalis pedis pulse. About 102 patients admitted in a tertiary care centre were enrolled for the study, and their dorsalis pedis pulse were examined by a portable Doppler and clinical methods. Two examiners, double-blinded, examined the dorsalis pedis artery using the conventional method and the new method independently, and documented their findings. Dorsalis pedis pulse was impalpable in 2.9% of cases by both methods. The palpae potami method located the dorsalis pedis pulse in 90% of cases, while the conventional method located dorsalis pedis pulse in 83.3% of cases. The palpae potami method has better sensitivity and specificity of 96.8% and 75%, respectively, while the conventional method had sensitivity and specificity of 86% and 50%, respectively. The mean duration taken by conventional method to locate the pulse was 4.7 s, while palpae potami took 31 s. The absence of dorsalis pulse was seen in 7.2% (8/102). The presence of systemic hypertension in patients lower the dorsalis pedis pulse detection in the conventional method (p = 0.0023), while no significant difference in pulse detection was found by the palpae potami method. The difficulties encountered by the conventional method in locating dorsalis pedis pulse could be reduced by this method. The new proposed method increased the chance of locating the dorsalis pedis artery significantly than by conventional method, which could be translated to higher case pickup of peripheral vascular diseases in a resource limited settings. Keywords PVD . Trauma . Pulse . Clinical examination
Introduction Pulse is a waveform produced as a result of cardiac output traversing through the arterial tree and felt by the palpating finger [1].Variation in the intensity of pulse wave stems from factors related to anatomical structures surrounding the artery such as subcutaneous fat, arterial size, systolic perfusion pressure [2] and neurovascular status of the patient, while level of
* Aravind Ravichandran [email protected] Aparnaa Balasubramanian [email protected] 1
Government Theni Medical College, 8/12 Dr.Varadharajalu Street, Chinna Chokkikulam, Madurai 625002, India
2
Government Theni Medical College, 1/18, Kongu Nagar, Vadugapalayam, Pollachi, Coimbatore 642001
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