How to Find a Pedal Pulse

In order to monitor and palpate the lower extremity pedal pulses, it is important to know the steps to follow. So, how can you find a pedal pulse?

In this article, we are going to talk about how to palpate foot pulses and provide you with a step by step guide to finding pedal pulses to check the circulation of blood in the lower extremities of the body.

 

What is a Pedal Pulse?

A pedal pulse is a pulse recorded in the arteries in the lower body. These arteries are located in the back of the ankle (Posterior Tibial Pulse) and the front of the foot (Dorsalis Pedis Pulse).

A study showed that some people have congenitally absent foot pulses. This study showed that .18% had absent posterior tibial pulses and 1.8% had absent dorsalis pedis pulses.

Although not that common, it is still important to take into consideration and check pulses in conjunction with a full comprehensive assessment.

If you don’t have a medical background and are concerned with not able to find your pulses, please consult with your health care professional.

 

When to check Pedal Pulses?

There are a number of reasons why health care professionals may want to check pedal pulses. These include:

  • Recent soft tissue trauma
  • Assessing circulation after limb fracture
  • If there is a splint in place, regular vascular checks are required to ensure there is a good blood supply. If splints are too tight, it may reduce blood flow to the feet
  • Pedal pulses are often checked in people with foot ulcers to ensure there is an adequate supply of blood, oxygen and nutrients to the limb and wound
  • If someone has symptoms of arterial disease that could be limiting blood flow to the feet
  • Any diabetics undergoing their regular podiatry assessment should have these pulses checked as part of their diabetic foot assessment.

Obtaining a pedal pulse is very important to establish if there is adequate blood flow; this is especially important in people with wounds on their feet.

 


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Pedal pulse location

It is essential to know how to palpate foot pulse because it could help in making quick time decisions in matters of life and death.

The pedal pulse location can sometimes be a tricky one, but once you get used to the location of the pedal pulse, it gets easier and easier.

Steps to Find Pedal Pulse

In order to find the pedal pulse of a patient undergoing a long-term or sudden physical injury, here is the step by step guide for medical professionals and interested people alike.

1. Check Radial Pulse

In order to establish a norm and to make sure you know what you’re looking for, you need to take the radial pulse of the patient.

This will be the starting point and a point of reference for the palpation of the pedal pulse. In order to do so, you’re going to need to hold your index and second finger tightly over the artery between the wrist bone and the thumb and press down gently until you can record the beats of the heart and appropriately observe the pulse.

 

2. Adjust or remove clothing

In order to assess the pedal pulse accurately, you may need to adjust or remove clothing so there is no restrictions around the limbs being assessed.

restrictive clothing that may affect the result of the assessment—in this case, removing the socks and pants if they are cutting in or restrictive in any way. This will reduce the added pressure on the legs, and the assessment will become much more accessible and comfortable as visibility will increase.

3. Position the Foot Comfortably

If the patient has gone through a bad injury, their leg might not be in good shape. Especially if they’re brought to the hospital in an emergency, the foot might not be in a comfortable position which might cause problems while taking the foot pulse assessment.

That’s why you need to make sure that you place the leg in a comfortable, normal position before you start the assessment. It will bring the blood flow to a normal measure so that the recorded pulse that you take is entirely realistic and isn’t altered in any way.

4. Identify Which Pulse to Check for

If you’re looking to check the pedal pulse, you have a couple of options to choose from.

The Dorsalis pedis pulse is located on the top of the foot while the Posterior Tibial Pulse is located behind the medial malleolus, which is also known as the ankle bone.

The Dorsalis pedis pulse can sometimes be difficult to locate. Using a landmark on the foot can help guide where to palpate for a pulse.

The prominence of the navicular bone provides that landmark to easily locate this pulse.

Locating the Dorsalis Pedis pulse using landmark for pedal pulse assessment.
Bones of foot- Navicular bone is an important landmark in finding Dorsalis Pedis Pulse.

 

5. Visualize the skin

In order to record the pulse, you must visualize the skin where you’re about to take the measurement.

Depending upon the region of the leg where you’re taking the pedal pulse from, the visualization might be different and the result also might be different.

If you’re taking the measure from Dorsalis Pedis, you might actually be able to see the skin pulsating above the artery.

If however, you’re not able to see this happen, you need to take appropriate measures in order to record the Dorsalis Pedis Pulse of the patient. And if you’re taking measure from the posterior end, you might not be able to see the pulsation.

6. Apply appropriate pressure

The main step is the step of applying pressure and recording the pedal pulse.

This is also different depending upon which method you might choose. If you’re taking pulse from the top of the foot, you can press above the pulsating skin and take the measure.

However, if the skin is not visibly pulsating, you can hold two fingers and press them against the skin, slowly moving upward on the leg and get the right measure.

If you’re taking pulse from the posterior tibial position, then you can use two or more fingers but know that this point requires a more firm grip and a tighter press in order to record the pulse accurately so be wary of that.

7. Check pulses on both feet

If the pulse in one of the legs is not easily assessable, then naturally you’re going to want to move to the other leg.

This way you can try assessing the pulse and then carry the same technique and press against the same area where the pulse was recorded on the other leg.

You can utilize the same effort here as well. If you’re able to find the appropriate pulse, use the same location to measure the pulse on the other leg. If not, there could be other problems.

8. Mark the location

Marking the location of the pulse can be great as well. Why? Well, in a patient who’s being treated for a disease lasting longer than a few days, the pulse may need to be recorded periodically throughout the day. This way you’ll know where to record the pulse from and the process of finding the pedal pulse will become much easier than usual.

9. Assessing the Temperature of the foot

The temperature of the foot also has a lot to do with the pulse and blood flow of the lower extremities of the patient’s body. If the temperature is cold, the pulse may not be normal. However, if the temperature of the leg is warmer, the blood flow will be closer to normality.

10. Recording the Pulse

Finally, you can take notes of the pulse. There are other determining factors as well like color, for example, if there is something off with the color of the skin, and the temperature isn’t normal either, there might be some severe blood flow problems in the patient. However, if the color of the leg is normal, then the blood circulation may also be normal.

What if You Can’t Find Pedal Pulse?

In most healthy people, you should be able to find the pedal pulse after utilizing the steps above.

However, in some extreme cases, you may not be able to find the pedal pulse. Decreased or absent pedal pulses are of concern.

Why does this happen? Well, here are the possibilities that might have occurred.

Arterial Bruises

There may have been an unfortunate event such as an accident or a problematic physical complication which the patient might have been in.

Due to such an occurrence, the patient may have received lower extremity injuries which are untreatable.

Due to this reason, it may be possible that the arteries may have been bruised ultimately halting blood carriage.

 

Venous Inflammation

Venous inflammation is when the veins become swollen and halt their functioning due to a condition called Thrombophlebitis.

Thrombophlebitis is due to the buildup of blood clots in the veins. Due to this reason, the blood flow might be interrupted and you might not be able to find the pedal pulse in the affected leg.

 

Peripheral Arterial Disease

Peripheral Artery Disease

Peripheral arterial disease (PAD) is a condition which disturbs blood circulation.

Found in approximately 12% of elderly people, PAD is a major risk factor for future cardiovascular events and death.

PAD refers to reduced blood flow through your arteries, commonly seen in the legs.

Intermittent Claudication is seen in people with PVD, and this can cause them to get leg cramping with simple tasks as walking.

TIP: People with long term arterial compromise may have no hairs on their legs. This is seen often in people with Peripheral Arterial Disease.

If your unable to locate any pulses or have any signs and symptoms of concern, further assessment by a health care professional is essential

In all of these conditions and many others causing peripheral pulse disorders, there are several treatments available, and you should adopt them in order to provide the patient with a satisfactory assessment.

Take home message

After properly finding and monitoring the pedal pulse, you can continue with other diagnostic activities and make sure that the proper treatment and medication is provided to the patients for their speedy recovery.

We assure you that you’ll be able to perfectly assess the foot pulse of patients using this step by step guide, ensuring efficiency, and taking care of patient emergencies.

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Emilie MASI

Registered Nurse, Masters in Advanced Nursing Practice Graduate Diploma of Wound Care Working towards Masters of Wound Care

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