A patient presents to the emergency department with a crushing injury to her right ankle. A medical student working there is told to evaluate the vascular integrity of the patient’s right lower extremity. She feels for femoral, dorsalis pedis, and posterior tibial pulses and finds that they are intact and symmetric bilaterally.In which of the following locations did the student palpate the posterior tibial pulse?

Immediately posterior to the medial malleolus

19. The correct answer is E. Recall that blood supply to the entire leg comes from the femoral artery. The femoral artery runs anteriorly on the thigh until reaching the adductor hiatus, where it dives deep and becomes the popliteal artery. The posterior tibial artery branches from the popliteal artery and runs deep in the calf until the ankle, where it lies in the superficial fossa immediately posterior to the medial malleolus. When there is a penetrating or crushing injury to the leg, it is important to palpate this artery and assess for symmetry. Answer A is incorrect. The posterior tibial artery does run between the heads of the gastrocnemius muscle, but it is deep in the leg and is not easily palpable. You should remember from anatomy that the palpable pulses in the leg are the femoral artery in the groin, the popliteal artery in the popliteal fossa on the posterior aspect of the knee, the posterior tibial posterior to the medial malleolus, and the dorsalis pedis in the first interosseous space on the dorsum of the foot. Answer B is incorrect. The popliteal artery is found in the popliteal fossa on the posterior aspect of the knee. Answer C is incorrect. There is no palpable artery anterior to the medial malleolus. Answer D is incorrect. The popliteal artery gives off three branches in the lower leg, one for each compartment: the posterior tibial, the fibular, and the anterior tibial artery. To assess the anterior tibial artery, one can palpate the dorsalis pedis pulse on the dorsal surface of the foot. The branches of the anterior tibial artery that supply the lateral ankle are too small to palpate. Answer F is incorrect. The dorsalis pedis artery runs along the dorsal surface of the foot and is a continuation of the anterior tibial artery.