|Year : 2015 | Volume
| Issue : 3 | Page : 302-304
Anomalous origin of dorsalis pedis artery and its clinical significance
P Ashwini Aithal, Jyothsna Patil, Melanie R D'Souza, Naveen Kumar, B Satheesha Nayak, Anitha Guru
Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka, India
|Date of Web Publication||12-Jun-2015|
Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal - 576 104, Karnataka
Source of Support: None, Conflict of Interest: None
Arterial variations of the lower limb have been reported in the past. However, we report in here a very unusual variation. During routine dissections, an anomalous origin of the dorsalis pedis artery (DPA) was noted on the right foot of an adult male cadaver. In here, the arteries of the crural region arose from the popliteal artery, as usual. However, the anterior tibial artery (ATA) was very slender. The peroneal artery (PA) was larger than usual and reached the anterior compartment of the leg by piercing the interosseous membrane at its lower part. In the foot, the ATA joined with the PA to form the DPA. Knowledge of such type of variations in the anatomy of DPA is important for angiographers, vascular surgeons and reconstructive surgeons who operate upon these regions.
Keywords: Anterior tibial artery, dorsalis pedis artery, peroneal artery, popliteal artery
|How to cite this article:|
Aithal P A, Patil J, D'Souza MR, Kumar N, Nayak B S, Guru A. Anomalous origin of dorsalis pedis artery and its clinical significance. CHRISMED J Health Res 2015;2:302-4
|How to cite this URL:|
Aithal P A, Patil J, D'Souza MR, Kumar N, Nayak B S, Guru A. Anomalous origin of dorsalis pedis artery and its clinical significance. CHRISMED J Health Res [serial online] 2015 [cited 2020 Jan 22];2:302-4. Available from: http://www.cjhr.org/text.asp?2015/2/3/302/158723
| Introduction|| |
Main arterial supply for the leg and foot is provided by branches of the popliteal artery. The popliteal artery is the continuation of the femoral artery at the popliteal fossa. It begins at the level of hiatus magnus and ends at the lower border of the popliteus muscle by dividing into anterior tibial and posterior tibial arteries.  The anterior tibial artery (ATA) enters the anterior compartment of the leg through the oval space located at the superior border of the interosseous membrane of the leg. There it travels on the anterior surface of the interosseous membrane along with the deep peroneal nerve and then the artery passes in front of the ankle to enter the dorsum of the foot and continues as the dorsalis pedis artery (DPA). The posterior tibial artery ends by dividing into the medial and lateral plantar arteries. The peroneal artery (PA) arises about 2.5 cm distal to the popliteus muscle from posterior tibial artery. Reaching the inferior tibiofibular syndesmosis, it divides into the calcaneal branches. An enlarged perforating branch of the PA may replace the DPA. In such case, the dorsalis pedis pulse will be absent.  The arterial feeders for the foot are derived from DPA and its branches on the dorsal aspect. There are few reports of the lateral deviation of DPA and higher bifurcation of ATA to form dorsalis pedis at the junction of upper 3/4 th and lower 1/4 th of leg.  However, we observed this unusual variation in the formation of the DPA, which has not been reported in the past.
| Case Report|| |
During routine dissection of an adult male cadaver aged approx. 60 years we came across this unilateral variation on the right side lower limb. We found that the ATA after its origin from the popliteal artery ran downward in the anterior compartment. It was very slender and of very thin caliber [Figure 1]. It commenced at the lower border of the popliteus muscle and then passed through the space above the upper border of the interosseous membrane and descended on the anterior surface of the latter. It then entered the dorsum of the foot passing deep to the flexor retinaculum. Posterior tibial artery had a normal course and distally divided into medial and lateral plantar arteries. The PA was larger than usual and crossed the lowest portion of the interosseous membrane, turned medially entering the dorsum of the foot. In the dorsum, the PA after giving the lateral calcaneal artery, continued distally and joined with the ATA to form the DPA [Figure 2]. Because of this, the DPA was found lateral to the deep peroneal nerve and had a more distal origin in the foot.
|Figure 1: Figure showing the anomalous origin of dorsalis pedis artery from anterior tibial artery and peroneal artery. Deep peroneal nerve is present medial to the artery. EDBM: Extensor digitorum brevis muscle|
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|Figure 2: Closer view of the variation showing a very slender anterior tibial artery, which joins with the peroneal artery to form the dorsalis pedis artery deep peroneal nerve|
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| Discussion|| |
Dorsalis pedis artery is the main source of artery to the dorsum of the foot. Variations of DPA are not uncommon, but such an anomalous origin of the artery formed by the joining of the PA with the ATA has not been reported in the past. The DPA arising from the perforating branch of PA has been reported.  A sound knowledge about the origin, course and branching pattern of this artery is essential, as it forms the stem for one of the major myocutaneous flaps, used for ankle surgeries in plastic and reconstructive surgeries. Due to such type of variations of the artery, it is very essential for arteriography to be taken prior to any foot flap surgeries.  In a cadaveric study, in around 8% of the cases DPA was arising as the continuation of PA.  Presence of 2 DPA arising from ATA has also been reported by Sharadkumar.  He has postulated that since DPA serves as an important pedicle for most of the reconstructive surgeries of the foot, the knowledge about the variation in the origin, branching and anastomosing patterns of the artery are of prime importance to the general surgeons, orthopedic surgeons, plastic and reconstructive surgeons who deal with this area.
The variations in the blood vessels and their anomalous course can be attributed to their development. Tiny blood vessels derived from the blood islands in the 3 rd or 4 th week of development, merge with each other and form a continuous network, from which buds grow out, canalize and form new vessels. New vessels of the neighborhood areas form a closed network. Depending on the functional dominance, some vessels regress and others diverge in the mode of origin and course from the principal vessel.  The lower limb vessels arise from two sources: The primary limb bud artery (axial or sciatic artery, a branch of the umbilical artery) and the femoral artery. The popliteal and fibular arteries arise from the axial artery, whereas the anterior tibial and posterior tibial arteries are derived from the femoral system. Variability in the crural arteries depends on both the regression of the sciatic artery and also on the persistence of its junction with the primary femoral artery in the popliteal region. 
Shetty et al. have reported a case where in the ATA was hypoplastic, and the PA continued as DPA.  The luminal diameter of the ATA is the most important determinant of the patency rate in anterior femorotibial graft.  In our case also we found that the anterial tibial artery was very thin and slender. It has been reported that the arterial variations as such might influence the success of femorodistal popliteal and tibial arterial reconstructions. In the absence of the posterior and anterior tibial arteries, the PA serves as the main source of blood supply to the foot.  Since in here the ATA was very slender, PA joined with it to supply the foot.
The knowledge of any variation in the course and distribution of the DPA is clinically important because the artery is used to record peripheral arterial pulsation. It is clinically important for surgeons operating on non-healing diabetic foot ulcers using musculocutaneous flaps to improve blood supply and soft tissue coverage, which is based on the branches and course of DPA. A lack of knowledge of such type of variations might complicate surgical repair and are thus of prime importance in surgical operative techniques. Prior confirmation by angiography for any such abnormalities will avoid unnecessary surgical risks.
The artery serves as an important landmark on the dorsum of foot and is recognized to play an important role in micro-vascular surgery of the foot during replantations, reconstruction and repair due to its unique anatomical position and bountiful supply to the foot.  Because of this, individual variations of the foot arteries are studied by arteriography before using extensor digitorum brevis or the skin of the dorsum of the foot as a flap.
| Conclusion|| |
Anomalies of lower limb vessels are incidentally found during anatomic dissections. They are of at most importance for angiographers and vascular surgeons who operate upon these regions as this can lead to confusion in interpretation of imaging study. DPA is an important landmark on the dorsum of the foot. We presume that reporting of such variations of the DPA is very important as it may lead to misinterpretation of the peripheral arterial pulse recording on the foot and also in other surgical operative techniques.
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[Figure 1], [Figure 2]