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Anatomy

Lower Limb

Question 59 of 180

You are performing a vascular examination on a patient with suspected claudication. The posterior tibial artery pulse is best palpated at which of the following sites:

Answer:

The posterior tibial pulse may be palpated posterior and inferior to the medial malleolus, midway between the medial malleolus and the heel.

Tibial Arteries

Anatomy / Lower Limb / Anterior Leg / Posterior Leg

Last Updated: 11th April 2019

After exiting the popliteal fossa between the gastrocnemius and popliteus muscle, the popliteal artery bifurcates into the anterior and posterior tibial arteries at the lower border of the popliteus.

Anterior Tibial Artery

The anterior tibial artery penetrates the interosseous membrane to enter and supply the anterior compartment of the leg, continuing inferiorly into the foot where it becomes the dorsalis pedis artery.

Posterior Tibial Artery

The posterior tibial artery descends through the deep region of the posterior compartment of the leg, giving rise to its two major branches, the circumflex fibular artery and the fibular artery and supplying the posterior and lateral compartments of the leg before passing posterior to the medial malleolus, and entering the sole of the foot via the tarsal tunnel.

The posterior tibial pulse may be palpated posterior and inferior to the medial malleolus, midway between the medial malleolus and the heel.

Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons

Tibial Arteries. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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