# Pedal Pulses



## WuLabsWuTecH (Aug 3, 2009)

I know I started a thread about this a long time ago, but rather than diggin up and old thread, I'll post a new one since they are as realted of questions as they could be.

My first thread I asked for assistance in locating pedal pulses.  I think I more or less have that skill down now, but this is my new problem.  No matter what, pedal pulses are always weak.

I can usually get a rate, but they just feel very weak.  I have never reported a pedal pulse as strong or even normal...  Perhaps it's only because I check pedal pulses when we backboard patients or other traumas, and before and after intervention they are the same weakness so I'm not concerned, but do any of you more experienced chaps have any advice or might know what I am doing wrong?


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## kecpercussion (Aug 3, 2009)

I always check pedal pulses at the top of the foot in line with the big toe. Always works for me


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## Shishkabob (Aug 3, 2009)

It's a relatively small artery at the very distal end of the circuit... not going to be TOO strong.  ^_^


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## daedalus (Aug 3, 2009)

You can check the posterior tibial pulse as well. It is located on the just to the side of the medial malleolus (the bony protrusion on the inner ankle). I like to check that pulse as opposed to the pedal because it is more readily palpated when the patient has shoes on, and I just need a quick assessment of the peripheral perfusion. However, the shoe comes off if needed.

The pedal pulse is usually not as strong as the radial or even popliteal. I would say it is normal for it to be around "2+" as opposed to "3+" (normal).


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## kecpercussion (Aug 3, 2009)

daedalus said:


> You can check the posterior tibial pulse as well. It is located on the just to the side of the medial malleolus (the bony protrusion on the inner ankle). I like to check that pulse as opposed to the pedal because it is more readily palpated when the patient has shoes on, and I just need a quick assessment of the peripheral perfusion. However, the shoe comes off if needed.
> 
> The pedal pulse is usually not as strong as the radial or even popliteal. I would say it is normal for it to be around "2+" as opposed to "3+" (normal).




I second this...IMO it really depends what i'm checking it for...if i need to do a full PMS then i will check pedal pulse because i will already be there so it makes it easier, but in any other case post tibial works great


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## Shishkabob (Aug 3, 2009)

I love the posterior tibial... makes me look less like a foot fetishist.


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## kecpercussion (Aug 3, 2009)

Or less of a pedicurist haha 

"What color would you like?"


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## WuLabsWuTecH (Aug 3, 2009)

I'm sorry, when I said pedal pulse, I meant posterior tibial.  My lack of precision of language is to blame.


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## daedalus (Aug 3, 2009)

WuLabsWuTecH said:


> I'm sorry, when I said pedal pulse, I meant posterior tibial.  My lack of precision of language is to blame.



?
The pulse on top of the foot is the pedal pulse, and the one on the ankle is the tibial. The tibial is not all that weak compared to the pedal. You may be palpating it wrong if you feel it to be very weak.


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## Ridryder911 (Aug 3, 2009)

daedalus said:


> ?
> The pulse on top of the foot is the pedal pulse, and the one on the ankle is the tibial. The tibial is not all that weak compared to the pedal. You may be palpating it wrong if you feel it to be very weak.



Actually, their all pedal pulses. The one on the foot is the posterior pedal and ankle is the distal tibial pulse. Pedal is a generic name for foot. 

When checking the posterior pulse, I have found to slide your index finger in the groove on top of the foot between the big toe and second toe. One usually can locate this much easier than the distal tibial. All distal pulses will have a decrease perfusion level in comparison to the ones more central. 

R/r 911


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## akflightmedic (Aug 3, 2009)

And do not forget the tip of the day...a small x once you are SURE you have located the pulse can be very helpful when you do reassessments or when you hand off care or when you ask someone else to check the pulse cause you are busy.


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## 8jimi8 (Aug 3, 2009)

And don't freak out if you find someone who does not have a posterior tibial pulse.  Some people just don't... even with a doppler.  You just may not have encountered someone with strong pedal pulses.  I've seen them strong enough to visualize the pulse.


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## NomadicMedic (Aug 3, 2009)

akflightmedic said:


> And do not forget the tip of the day...a small x once you are SURE you have located the pulse can be very helpful when you do reassessments or when you hand off care or when you ask someone else to check the pulse cause you are busy.



Or, if they're like some of the patients that I transport, there will be track marks over the Dorsalis Pedis from all of the H that's been shot in there. Makes a nice landmark. True story.


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## WuLabsWuTecH (Aug 3, 2009)

Ridryder911 said:


> Actually, their all pedal pulses. The one on the foot is the posterior pedal and ankle is the distal tibial pulse. Pedal is a generic name for foot.
> 
> When checking the posterior pulse, I have found to slide your index finger in the groove on top of the foot between the big toe and second toe. One usually can locate this much easier than the distal tibial. All distal pulses will have a decrease perfusion level in comparison to the ones more central.
> 
> R/r 911




+1, I think that was very helpful.  I can find it on most everyone now (well the 3 people that are sitting in the room with me!) and while i still think its weak, its stronger than before!


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## FFMckenzie (Aug 4, 2009)

Just as an observation I always seem to find that people with higher percents of body fat I seem to have a harder time finding a pulse in general. Skinny people sometimes you can visually see the pulse.

I guess the thicker subcutaneous layer can tend to muffle what you can feel. Or you can be cursed like me and have very insensitive fingers.


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## falcon-18 (Aug 4, 2009)

Ridryder911 said:


> When checking the posterior pulse, I have found to slide your index finger in the groove on top of the foot between the big toe and second toe. One usually can locate this much easier than the distal tibial. All distal pulses will have a decrease perfusion level in comparison to the ones more central.
> 
> R/r 911




this is the best to describe  checking pulse . It was difficult . but now it is very easy for any one read this. thanks


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## DWemt28 (Aug 5, 2009)

i've noticed that to find a pedal pulse, you shouldnt palpate as hard on the spot.....if you touch it very gently you can feel it a little bit better.....it is rather weak though


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