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Finding a pedal pulse is part of the trauma patient assessment and performed before and after lower extremity splint application as well as long backboard immobilization. Assessing a pedal pulse is part of the ongoing assessment for a patient on a backboard or a lower extremity splint. During hospital care, nurses and CNAs, might need to find and document lower extremity circulation for bed-bound patients.

Locating a foot pulse can be difficult even in healthy patients. Use these tips to find a patient’s pedal pulses:

1. Radial pulse first

Assess the patient’s radial pulse rate and rhythm so you know what you are seeking.

2. Bare the patient’s skin

Move shoes, socks, tights, and anklets out of the way to expose the patient’s skin.

3. Reposition the foot to normal

Move, if not compromised by injury, the patient’s foot towards the normal anatomical position.

4. Two possible pedal pulse positions to check

Check for either the dorsalis pedis pulse (on the top of the foot) or the posterior tibial pulse (located behind the medial malleolus — the ankle bone).

5. Visualize skin for pulsation

For dorsalis pedis, first, visualize because you might see the skin pulsating above the artery. If you are unable to see anything, hold two or more fingers lightly against the skin. Move up from the toes towards the leg until you locate the pulse.

6. Use two or more fingers

For posterior tibial — on the medial side of the ankle — use two or more fingers. I find more pressure is needed to find this pulse.

7. Try the other leg

If you are unable to find the pedal pulse on one leg, switch to the patient’s other leg. Knowing the location of one pulse might help you find the other.

8. Mark the location

Once you have found a pedal pulse, consider using a ballpoint or felt pen to make a light mark at the pulse location to make reassessment easier.

9. Foot temperature and color

Finally, if the patient’s foot is warm with normal color, it is adequately perfused.

What else works well for finding a pedal pulse? Why might a pedal pulse be absent or diminished? Share your thoughts in the comments area.

This article, originally published December 7, 2009, has been updated.