Morphometric Analysis, Anatomical Variations and Histological Evaluation of the Dorsalis Pedis Artery in Human Cadavers: Implications for Clinical and Surgical Practice

Morphometric Analysis, Anatomical Variations and Histological Evaluation of the Dorsalis Pedis Artery in Human Cadavers: Implications for Clinical and Surgical Practice | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Morphometric Analysis, Anatomical Variations and Histological Evaluation of the Dorsalis Pedis Artery in Human Cadavers: Implications for Clinical and Surgical Practice Harika Gali, Anne Dsouza, Chandni Gupta, Mamatha Hosapatna, Rohini Punja, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7813762/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose The dorsalis pedis artery (DPA), the primary arterial supply to the dorsum of the foot, is a critical landmark in clinical and surgical procedures. While its morphometry and variations has been well studied, limited data exist on its histological characteristics. This study aimed to analyze the histology, morphometry and anatomical variations of the DPA. Methods Fifty lower limbs from 25 cadavers were examined at the Department of Anatomy, Kasturba Medical College, Manipal, following IEC approval. The length of the DPA and arcuate artery was measured. The distance of the arcuate artery from the origin of the dorsalis pedis artery and the distance of DPA from the medial and lateral malleolus were also measured. A segment distal to the mid-malleolar point was harvested for histological analysis. Anatomical variations were documented. Results The mean DPA length was 7.53 ± 0.53 cm (right) and 8.0 ± 2.02 cm (left). The arcuate artery measured 4.8 ± 1.82 cm (right) and 4.9 ± 0.91 cm (left), arising approximately 4.41 ± 1.42 cm and 4.6 ± 1.11 cm from the DPA origin on the right and left sides, respectively. Four variations in the emergence of dorsal metatarsal arteries were observed. Histological findings included basophilic calcification of the tunica media in six specimens—three with additional involvement of the internal elastic lamina—and thrombotic occlusion with tunica intima disruption in three cases. Conclusion Detailed knowledge of the DPA’s morphometry and histology enhances the precision of surgical interventions and supports early diagnosis of peripheral vascular pathologies. Dorsalis pedis artery Arcuate artery Ankle surgeries Peripheral arterial diseases Basophilic calcification Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Introduction The dorsalis pedis artery (DPA), a continuation of the anterior tibial artery, plays a key role in perfusion of the dorsal foot and serves as a clinical marker in peripheral vascular examination. Its palpability lateral to the extensor hallucis longus tendon makes it a primary site for assessing peripheral arterial integrity [ 24 , 26 ]. Absence or alteration of its pulse may indicate peripheral arterial diseases (PAD), such as atherosclerosis, thrombotic occlusion, or medial arterial calcification—conditions commonly associated with diabetes, smoking, or renal disease [ 12 , 17 ]. Pathological changes in arterial walls, including intimal atherosclerosis and medial sclerosis (Mönckeberg’s), can alter the functional and structural integrity of the artery [ 15 , 19 ]. Furthermore, traumatic or iatrogenic injuries to the DPA—especially during ankle arthroscopies—may lead to pseudoaneurysms or impaired wound healing [ 4 ]. Anatomically, the DPA is the continuation of the anterior tibial artery from the mid-malleolar point. It travels over the dorsum of the foot alongside the deep peroneal nerve, terminating in the first intermetatarsal space by giving rise to the deep plantar artery and first dorsal metatarsal artery (DMA) [ 7 , 20 ]. The arcuate artery, a significant branch, runs laterally on the bases of metatarsal bones deep to the extensor tendons and gives rise to the 2nd, 3rd, and 4th DMAs, with variations being relatively common [ 24 ]. As the DPA is the largest artery distal to the ankle joint, it is highly preferred for foot flaps and pedal revascularization in diabetic patients to promote healing and help avoid major amputations. Its fascio-cutaneous flaps have been used for oral cavity reconstruction in oral cancer patients and also for hand defects. The first dorsal metatarsal artery flap is most commonly used for toe-to-finger transplants, and the success of these transplants depends on the diameter of the artery [ 7 , 20 , 28 ]. A comprehensive understanding of the DPA's branching anatomy, common variations, and histological features is crucial for effective preoperative planning and successful reconstructive surgeries. Despite its clinical significance, there remains a lack of detailed histological studies examining the structural variations and wall architecture of the dorsalis pedis artery. The integration of anatomical and histological perspectives enhances understanding of vascular pathophysiology, optimizes surgical planning. Materials and methods The study was conducted on 50 lower limbs (25 cadavers) from the Department of Anatomy, Kasturba Medical College, Manipal, following approval from the institutional ethics committee (Ref: IEC2: 725/2023). DPA and its branching pattern were observed during routine dissection classes for undergraduate students. Dissection Procedure After reflecting the skin and superficial fascia, the extensor retinaculum was incised to expose the dorsalis pedis artery. The artery was carefully traced from its origin to its termination, including the arcuate artery, which was also followed along its entire course. Variations in the origin and branching pattern were observed. Morphometric Evaluation The following measurements were taken on both right and left limbs using Vernier calipers. The length of the dorsalis pedis artery, measured from an imaginary line connecting the medial and lateral malleoli to the first intermetatarsal space, as illustrated in (Fig. 1 A). The length of the arcuate artery. The distance from the origin of the dorsalis pedis artery to the origin of the arcuate artery, as shown in (Fig. 1 B). The distance of the dorsalis pedis artery from the medial and lateral malleoli. Descriptive statistics were performed for the morphometric data. Histological Evaluation Ten specimens were processed for histological examination to analyze the normal arterial wall architecture and identify any pathological changes. Histological processing and analysis are labor-intensive and resource-demanding, so a representative number of specimens was deemed sufficient to provide qualitative insights into the normal histology of the dorsalis pedis artery without compromising study feasibility. This smaller number balances thorough analysis with practical constraints of time and resources. A segment of the dorsalis pedis artery was harvested from the dorsum of the foot, just distal to the mid-malleolar point, during routine cadaveric dissection for undergraduate teaching. The samples were dehydrated using graded alcohol concentrations (50%, 70%, 90%, and 100%), cleared in xylene, and embedded in paraffin wax. Serial sections of 5 µm thickness were prepared using a rotary microtome and mounted on glass slides. The slides were stained with hematoxylin and eosin (H&E) and examined under a microscope (Olympus CX 41) equipped with a U-TV1X-2 camera (Tokyo, Japan) for detailed photographic documentation. Result Morphometric Analysis Descriptive statistics of the dorsalis pedis artery (DPA) parameters are summarized in Table 1 . The mean length of the dorsalis pedis artery was 7.53 ± 0.53 cm on the right leg and 8.0 ± 2.02 cm on the left leg. The arcuate artery measured 4.8 ± 1.82 cm on the right and 4.9 ± 0.91 cm on the left. The length of the arcuate artery from the origin of the DPA was 4.41 ± 1.42 cm on the right side and 4.6 ± 1.11 cm on the left. The distance of the DPA from the medial malleolus was 3.5 ± 1.52 cm on the right leg and 4.01 ± 1.02 cm on the left leg. The distance from the lateral malleolus was consistent at 5.5 ± 1.52 cm on both legs. Table 1 Presentation of Descriptive Statistics. PARAMETERS Right leg (cm) (Mean ± SD) Left leg (cm) Mean ± SD) Length of dorsalis pedis artery 7.53 ± 0.53 8.0 ± 2.02 Length of Arcuate artery 4.8 ± 1.82 4.9 ± 0.91 Length of Arcuate artery from origin of DPA 4.41 ± 1.42 4.6 ± 1.11 Distance of DPA from medial malleolus 3.5 ± 1.52 4.01 ± 1.02 Distance of DPA from lateral malleolus 5.5 ± 1.52 5.5 ± 1.52 Variations In the present study, five distinct patterns of the dorsalis pedis artery and its branches were observed: Type 1 (92% cases) : The anterior tibial artery continued as the dorsalis pedis artery with a typical course and branching pattern (Fig. 2 ). Type 2 (2% cases) : The anterior tibial artery bifurcated into the dorsalis pedis artery and lateral tarsal artery. The DPA extended to the first intermetatarsal space, giving off the first dorsal metatarsal artery and deep plantar artery. The DPA also gave the second DMA, while the lateral tarsal artery supplied the third and fourth DMA. Notably, the arcuate artery was absent in this type (Fig. 3 ). Type 3 (2% cases) : Similar bifurcation of the anterior tibial artery into DPA and lateral tarsal artery was observed. The DPA supplied the first DMAand deep plantar arteries. The lateral tarsal artery divided into medial and lateral branches; the medial branch formed the arcuate artery, which gave rise to the second, third, and fourth DMA. The lateral branch supplied the upper lateral foot. Second DMA dipped into the sole. There was no communication between the first and second DMA(Fig. 4 ). Type 4 (2% cases) : The DPA gave off medial and lateral malleolar arteries. Distal to the lateral malleolar artery, the DPA gave the lateral tarsal artery, and further distal, a recurrent artery arose to join the lateral tarsal artery forming a U-shaped loop. This recurrent artery gave rise to the fourth DMA. The DPA continued to the first intermetatarsal space, giving the first dorsal metatarsal and deep plantar arteries. The arcuate artery arose near the metatarsal heads, supplying the second and third DMA. (Fig. 5 ). Type 5 (2% cases) : The anterior tibial artery divided into the DPA and lateral tarsal artery (Fig. 6 A& 6 B). The DPA reached the first intermetatarsal space, giving two DMA and the deep plantar artery (Fig. 6 C& 6 D). The second and fourth DMA originated from the plantar arch and were not branches of the DPA or lateral tarsal artery (Figs. 6 A& 6 B). The lateral tarsal artery supplied the third DMA, which gave two branches entering the sole (Fig. 7 ). Histology Out of ten tissue specimens examined, only one showed a normal histological structure with intact tunica intima, media, adventitia, and internal and external elastic lamina, without any pathological features (Fig. 8 ). One specimen revealed duplication of the internal elastic lamina, visible as split layers (Fig. 10 A&B). Three specimens showed intimal thickening with luminal occlusion due to plaque formation and disruption of the IEL (Fig. 11). Fig .11. Showing Occlusion of lumen with plaque. T.I- tunica intima, T.M- tunica media, T.A- tunica adventitia. Discussion Variations in arteries and their abnormal courses are closely associated with developmental processes. During the 4th week of embryogenesis, small vascular channels arise from blood islands and coalesce to form a continuous primitive network. From this network, buds emerge, canalize, and form new blood vessels and interconnect with neighboring vessels to establish a closed vascular network. As development progresses, certain channels enlarge while others regress, depending on functional dominance. This selective persistence and regression lead to differences in the origin and course of arteries, and the dorsalis pedis artery is particularly well known for such variations [ 27 ]. Several previous studies observed various types of variations in the branching pattern of the DPA, which include: Type A – standard vascular pattern of DPA; Type B – absence of DPA; Type C – absence of arcuate artery; Type D – arcuate artery absence with variations in number of lateral tarsal arteries; Type E – variation in origin of the second dorsal metatarsal artery; Type F – variation in origin of DPA and lateral tarsal arteries; Type G – poorly formed DPA and lateral tarsal arteries; Type H – arcuate artery forming U-shaped loop and double DPA (anterior tibial artery divides into two DPAs) [ 9 ]. In the present study, the standard pattern of the dorsalis pedis artery (DPA), characterized by the continuation of the anterior tibial artery as the DPA with its typical course and branching, was observed in 92% of cases, while variations accounted for 8%. Type-1: A comparison of the Type-1 standard pattern from the current study with previous reports is presented in Table 2 . Type-2: Luckrajh et al. [ 13 ] and Rajeshwari et al. [ 20 ] reported Type-2 variations in 7.5% and 2.38% of their respective samples, where the DPA gave rise to the 1st and 2nd DMA, while the 3rd and 4th arose from the lateral tarsal artery. In our study, a similar pattern was observed in 2% of cases. Type-3: Awari & Vatsalaswamy et al. [ 2 ] documented that the DPA gave rise only to the 1st dorsal metatarsal artery, with the 2nd, 3rd, and 4th DMA arising from the lateral tarsal artery in 40% of specimens. Rajeshwari et al. [ 20 ] reported similar findings in 10% of cases. Other studies by Dilandro et al. [ 5 ], Vijayalakshmi et al. [ 27 ], Kumari & Bharti et al. [ 10 ], and Luckrajh et al. [ 13 ] noted comparable variations ranging from 5% to 6%. Our study observed this pattern in 2% of cases. Type-4: Luckrajh et al. [ 13 ] and Rajeshwari et al. [ 20 ] reported the presence of both proximal and distal lateral tarsal arteries forming a loop that gave rise to the 2nd, 3rd, and 4th DMA in 5% and 2.8% of cases, respectively. Additionally, Luckrajh et al. [ 13 ] described a U-shaped loop with a recurrent artery connecting the proximal and distal lateral tarsal arteries in 2.5% of cases. In our study, 2% of cases demonstrated the DPA giving rise to the lateral tarsal artery, which formed a U-shaped loop with a recurrent artery. This recurrent artery gave rise to the 4th DMA, while the DPA itself gave rise to the 1st DMA and the arcuate artery. The arcuate artery then gave rise to the 2nd and 3rd DMA. Type-5: Hemamalini et al. [ 7 ] reported that the 2nd, 3rd, and 4th DMA arose from the plantar arch in 8% of cases. In contrast, our study observed that the 2nd and 4th DMA arose from the plantar arch, the 1st from the DPA, and the 3rd from the lateral tarsal artery. Vazquez et al. [ 26 ] documented that in 1.3% of cases, the perforating branch of the fibular artery replaced the course of the DPA. However, in the present study, the anterior tibial artery continued as the DPA in all specimens. Yamada et al. [ 29 ] and Reich et al. [ 21 ] reported the absence of DPA in 6.7% and 14.2% of cases, respectively. Ntuli et al. [ 16 ] reported 6.06%, where dorsal metatarsal arteries were given by the plantar arteries. Conversely, in our study, the DPA was present in all cases. Lee et al. [ 12 ] reported that the first dorsal metatarsal artery originated from DPA in 90.6% of cases and from the lateral tarsal artery in 9.4%. In our study, the first DMA consistently originated from the DPA in all specimens. Hemamalini et al. [ 7 ] found trifurcation of DPA, which was not found in our study. Comparison of standard patterns and variations of the Arcuate artery and DPA with other authors is shown in Table 2 . Table 2 Comparative Analysis of the Standard Anatomy and Variations of the Dorsalis Pedis Artery and Arcuate Artery in Relation to Previous Studies AUTHORS STANDARD PATTERN ABSENCE OF ARCUATE ARTERY f arcuate artery ABSENCE OF DPA Rajeshwari et al [ 9 ] 54.76% 16.7% 9.52 Vazquez et al [ 2 ] 95.7% N/A N/A Reich et al[ 18 ] 74% N/A 14.2 Lee et al. [ 12 ] 90.6% N/A N/A Ntuli et al [ 19 ] 36.4% 15.2% N/A Vijayalakshmi et al [ 11 ] 56% 6% 2% Gupta et al [ 20 ] 91% 3% 3% Present study 92% 6% N/A The morphometric parameters obtained in this study, such as artery length and malleolar distances, are generally consistent with previous findings, although notable population-specific variations were observed. These measurements are critical for accurate clinical localization of the artery during pulse examination and invasive interventions. Chandini Gupta et al [ 6 ] reported 3% of absence of arcuate artery and the authors stated that DPA is not always at mid-malleolar point on the basis of measurement they got. They measured the mean distance of DPA from medial malleolus, which was 3.9cm, and from the lateral malleolus which was 6cm. In comparison, our study reported the following measurements: on the right side, the DPA was located at an average distance of 3.5 ± 1.52 cm from the medial malleolus and 5.5 cm from the lateral malleolus; on the left side, the distances were 4.01 ± 1.02 cm from the medial malleolus and 5.5 ± 1.52 cm from the lateral malleolus. Additionally, Gupta et al. observed an average DPA length of 7.8 cm, while our findings showed an average length of 7.53 cm. Furthermore, our study reported a 4% absence rate of the arcuate artery. Thunyacharoen et al [ 25 ] reported that the mean length of DPA in right side is 11.96 ± 2.4 and in left side it is 12.44 ± 1.7. We reported average length in right side as 7.53 ± 0.53 and in left side as 8.0 ± 2.02 in our study. They also reported the distances of the DPA of the right leg to the lateral malleolus and medial malleolus were 5.15 ± 6.30 and 4.09 ± 7.3 and the distances of the DPA of the left leg to the lateral malleolus and medial malleolus were 5.13 ± 8.0 and 4.17 ± 8.1respectively. We reported average distance of DPA from lateral malleolus and medial malleolus 3.5 ± 1.52 and 5.5 ± 1.52 in right leg and 5.5 ± 1.52 in left leg in our study. The histological findings are consistent with the classical characterization of Mönckeberg’s sclerosis, a form of medial arterial calcification first described by Mönckeberg in 1903. He observed fine calcium granules localized along the elastic lamina, occurring without extensive calcification of the arterial media. Out of 10 DPA specimens, 6 showed the basophilic deposits suggestive of calcification with intimal thickening and calcium deposits extended to involve the internal elastic lamina (IEL) in 3 tissue specimens. Since calcification in medial sclerosis (MS) can affect both the internal elastic lamina (IEL) and the media, different authors have proposed varied sites of origin. In their observations, calcium deposits were sometimes seen along the internal elastic lamina (IEL), while in other cases, it appeared as nodules or bands within the media. These nodules were often connected to calcified areas of the IEL in nearby planes, but when viewed alone, they could give the impression of calcification limited to the media [ 14 ]. Some have suggested that the earliest changes occur in the IEL, beginning with loss of its normal undulation, altered staining features, and eventually disruption and calcification of the membrane. Others have described the process as starting within the media, related to degeneration of smooth muscle cells, possibly due to reduced blood supply in the mid-zone. Based on their observations, it has been proposed that calcification may originate at or just beneath the IEL, given its frequent involvement and close association with medial deposits [ 1 ]. Klotz et al. [ 8 ] and Abramson et al. [ 1 ] observed early deposits at the IEL that extended into the media, which is consistent with the observations in our study, where the major part of the calcium deposits was within the internal elastic lamina and a smaller portion in the media. Silbert et al. [ 22 ] described calcium deposits in the connective tissue fibrils between smooth muscle cells that often disrupt the IEL, while the disruption of the internal elastic lamina by the calcium deposits was observed in our study. Peery & Miller et al. [ 18 ] reported that calcium deposits were predominantly located within the arterial media, often involving the internal elastic lamina (IEL). In our study of six specimens, IEL involvement was observed in three cases, whereas in the remaining three specimens, calcification was confined exclusively to the medial layer. Lachman et al. [ 11 ] reported medial arterial calcification with sparing of both the internal and external elastic laminae in all examined specimens. In contrast, our study observed sparing of the internal elastic lamina in only three cases. Silver et al. [ 23 ] and Burke and Virmani et al. [ 3 ] reported that calcium deposits may originate at the internal elastic lamina (IEL) and subsequently extend into the medial layer. This progression underscores the variability of the pathological process, a pattern that aligns with the findings observed in our study. Robert G et al. [ 14 ] reported that all specimens in their study exhibited calcium deposits involving the internal elastic lamina (IEL), whereas in our study, IEL involvement was observed in only three specimens. Therefore, the integration of variations, morphometric, and histological data offers a comprehensive framework for elucidating the structure and pathology of the dorsalis pedis artery (DPA) in both normal and diseased states. Conclusion The dorsalis pedis artery is a critical vessel for assessing foot circulation, with its pulse typically palpable lateral to the extensor hallucis longus tendon. Knowledge of the variations in the origin and branching patterns of the DPA is essential for differentiating normal anatomical differences from pathological conditions such as aneurysms, deep vein thrombosis, and peripheral arterial diseases. The DPA also plays a vital role in ankle surgeries and revascularization procedures. Histological examination provides valuable insights into arterial wall changes, such as intimal thickening, medial calcification, and alterations in elastic laminae, aiding in the identification of vascular diseases including Mönckeberg’s sclerosis. Together, anatomical and histological understanding enhances clinical assessment and surgical management of foot vascular conditions. Limitations Only 50 lower limbs from 25 cadavers were examined, which is a relatively small sample for generalizing findings, especially for anatomical variations that may have population-specific prevalence. Only ten histological specimens were examined from the 50 limbs studied. This small histological sample may not adequately represent the full spectrum of vascular pathology or normal variation in the population. Furthermore, histological analysis was limited to a single site (just distal to the mid-malleolar point), potentially missing regional variations along the length of the artery. Special stains, such as Von Kossa or Alizarin Red S, could be used to confirm the presence of calcium deposits in the tunica media. Abbreviations DPA Dorsalis Pedis artery DMA Dorsal metatarsal artery LTA Lateral tarsal artery PAD Peripheral arterial disease T.I Tunica intima T.M Tunica media T.A Tunica adventitia IEL Internal elastic lamina EEL External elastic lamina Declarations Ethical declaration The informed written consent from the patients follows the tenets of the Declaration of Helsinki. The clearance was obtained from the Ethics Committee of Kasturba Medical College, Manipal (IEC2-725-2023). The consent was obtained during the body donation; therefore, individual consent was waived by the ethics committee of Kasturba Medical College. Human Ethics and Consent to Participate declarations : not applicable. Funding Declaration This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. 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1","display":"","copyAsset":false,"role":"figure","size":60797,"visible":true,"origin":"","legend":"\u003cp\u003eShowing the measurements of DPA. A: Length of DPA B: Length of Arcuate artery\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/fec16609f9f546412d396612.png"},{"id":94474572,"identity":"8febab66-800a-4f8b-a1ac-c54bb2526a48","added_by":"auto","created_at":"2025-10-27 15:49:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":30243,"visible":true,"origin":"","legend":"\u003cp\u003eDPA- Dorsalis pedis artery, DMA- Dorsal metatarsal artery\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/6a3e7619548d4c835074c3a0.png"},{"id":94474316,"identity":"b86997d7-7b6d-4e10-b15d-7d90e6f51834","added_by":"auto","created_at":"2025-10-27 15:48:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":31462,"visible":true,"origin":"","legend":"\u003cp\u003eDPA- Dorsalis pedis artery, LTA- Lateral tarsal artery, DMA- Dorsal metatarsal artery\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/78cbcb79ad0e897d22cfa560.png"},{"id":94474383,"identity":"fa6dadc9-d959-45a4-b4f4-577e84927287","added_by":"auto","created_at":"2025-10-27 15:48:44","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":265174,"visible":true,"origin":"","legend":"\u003cp\u003eDPA- Dorsalis pedis artery, LTA- Lateral tarsal artery, DMA- Dorsal metatarsal artery\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/609b73993a9f57cd29521343.png"},{"id":94473882,"identity":"d0e36079-8a53-41ab-9cea-b7080aa2cb22","added_by":"auto","created_at":"2025-10-27 15:46:12","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":58706,"visible":true,"origin":"","legend":"\u003cp\u003eShowing that 4\u003csup\u003eth\u003c/sup\u003e dorsal metatarsal artery arised from lateral plantar artery DPA- Dorsalis pedis artery, LTA- Lateral tarsal artery, DMA- Dorsal metatarsal artery\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/72b5552ed27dddf88e342bd9.png"},{"id":94474436,"identity":"b3073e79-74cf-452c-bce0-cd183458a575","added_by":"auto","created_at":"2025-10-27 15:48:56","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":95441,"visible":true,"origin":"","legend":"\u003cp\u003eA\u0026amp;B Showing the division of Anterior tibial artery into DPA and Lateral tarsal artery\u003c/p\u003e\n\u003cp\u003eD: Arrow mark showing the second artery given by Dorsalis pedis artery in the 1\u003csup\u003est\u003c/sup\u003e intermetatarsal space.\u0026nbsp; DPA- Dorsalis pedis artery, LTA- Lateral tarsal artery, DMA- Dorsal metatarsal artery\u0026nbsp;\u003c/p\u003e","description":"","filename":"floatimage6.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/3c231e4e16d2ef708e08ed6c.png"},{"id":94474612,"identity":"17084a5b-78dd-43c4-a2a1-9e1a25360170","added_by":"auto","created_at":"2025-10-27 15:49:32","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":70503,"visible":true,"origin":"","legend":"\u003cp\u003eArrow mark showing the two branches of 3\u003csup\u003erd\u003c/sup\u003e dorsal metatarsal artery coming from the sole\u003c/p\u003e","description":"","filename":"floatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/f21dedd6290635336e1fb505.png"},{"id":94473812,"identity":"3d57061e-4f81-4e18-a1d7-6e1813575c4c","added_by":"auto","created_at":"2025-10-27 15:45:46","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":66041,"visible":true,"origin":"","legend":"\u003cp\u003ePictograph of H\u0026amp;E stained slide showing the normal pattern of artery. T.I- tunica intima, T.M- tunica media, T.A- tunica adventitia, IEL – Internal elastic lamina, EEL- External elastic lamina\u003c/p\u003e","description":"","filename":"floatimage8.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/64c4096f032f065cc4e2af96.png"},{"id":94474002,"identity":"2b52d8d0-d6f7-4d6b-aa60-5c521330b511","added_by":"auto","created_at":"2025-10-27 15:46:38","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":533862,"visible":true,"origin":"","legend":"\u003cp\u003ePictograph of H\u0026amp;E stained slide \u003cstrong\u003eA\u0026amp;B – 4x-\u003c/strong\u003eArrow mark showing the Basophilic deposits suggestive of calcification in tunica media. \u003cstrong\u003eC-\u003c/strong\u003e Involvement of Internal elastic lamina (IEL) with basophilic calcification, picture was taken in 4x. \u003cstrong\u003eD- \u003c/strong\u003eInvolvement of IEL picture was taken in 10x. \u003cstrong\u003eE-\u003c/strong\u003e10x Basophilic deposits suggestive of calcification confined to tunica media.\u003c/p\u003e","description":"","filename":"floatimage9.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/3761bbc8897e569ac25fbe39.png"},{"id":94474610,"identity":"e43c4a38-2cfc-4655-8822-11b38fbcc3d9","added_by":"auto","created_at":"2025-10-27 15:49:32","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":48744,"visible":true,"origin":"","legend":"\u003cp\u003ePictograph of H\u0026amp;E-stained slide \u003cstrong\u003eA\u0026amp;B-\u003c/strong\u003eArrow mark showing the duplication of internal elastic lamina\u003c/p\u003e","description":"","filename":"floatimage10.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/20c9fb3e2bca50c05ddda3c3.png"},{"id":94474128,"identity":"c3569d9c-0e73-42f6-9820-5fed81659218","added_by":"auto","created_at":"2025-10-27 15:47:33","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":55351,"visible":true,"origin":"","legend":"\u003cp\u003eShowing Occlusion of lumen with plaque. T.I- tunica intima, T.M- tunica media, T.A- tunica adventitia.\u003c/p\u003e","description":"","filename":"floatimage11.png","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/b22a5687b8b883bf5f7a2cf9.png"},{"id":97667360,"identity":"3703fe1d-86f2-4ca5-91e2-c307b0dd054f","added_by":"auto","created_at":"2025-12-08 09:23:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2061171,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7813762/v1/1fcf0b89-ab40-4e80-bbb2-065454687baf.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Morphometric Analysis, Anatomical Variations and Histological Evaluation of the Dorsalis Pedis Artery in Human Cadavers: Implications for Clinical and Surgical Practice","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe dorsalis pedis artery (DPA), a continuation of the anterior tibial artery, plays a key role in perfusion of the dorsal foot and serves as a clinical marker in peripheral vascular examination. Its palpability lateral to the extensor hallucis longus tendon makes it a primary site for assessing peripheral arterial integrity [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Absence or alteration of its pulse may indicate peripheral arterial diseases (PAD), such as atherosclerosis, thrombotic occlusion, or medial arterial calcification\u0026mdash;conditions commonly associated with diabetes, smoking, or renal disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Pathological changes in arterial walls, including intimal atherosclerosis and medial sclerosis (M\u0026ouml;nckeberg\u0026rsquo;s), can alter the functional and structural integrity of the artery [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Furthermore, traumatic or iatrogenic injuries to the DPA\u0026mdash;especially during ankle arthroscopies\u0026mdash;may lead to pseudoaneurysms or impaired wound healing [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAnatomically, the DPA is the continuation of the anterior tibial artery from the mid-malleolar point. It travels over the dorsum of the foot alongside the deep peroneal nerve, terminating in the first intermetatarsal space by giving rise to the deep plantar artery and first dorsal metatarsal artery (DMA) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The arcuate artery, a significant branch, runs laterally on the bases of metatarsal bones deep to the extensor tendons and gives rise to the 2nd, 3rd, and 4th DMAs, with variations being relatively common [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. As the DPA is the largest artery distal to the ankle joint, it is highly preferred for foot flaps and pedal revascularization in diabetic patients to promote healing and help avoid major amputations. Its fascio-cutaneous flaps have been used for oral cavity reconstruction in oral cancer patients and also for hand defects. The first dorsal metatarsal artery flap is most commonly used for toe-to-finger transplants, and the success of these transplants depends on the diameter of the artery [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eA comprehensive understanding of the DPA's branching anatomy, common variations, and histological features is crucial for effective preoperative planning and successful reconstructive surgeries. Despite its clinical significance, there remains a lack of detailed histological studies examining the structural variations and wall architecture of the dorsalis pedis artery. The integration of anatomical and histological perspectives enhances understanding of vascular pathophysiology, optimizes surgical planning.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003e The study was conducted on 50 lower limbs (25 cadavers) from the Department of Anatomy, Kasturba Medical College, Manipal, following approval from the institutional ethics committee (Ref: IEC2: 725/2023). DPA and its branching pattern were observed during routine dissection classes for undergraduate students.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eDissection Procedure\u003c/h2\u003e\u003cp\u003eAfter reflecting the skin and superficial fascia, the extensor retinaculum was incised to expose the dorsalis pedis artery. The artery was carefully traced from its origin to its termination, including the arcuate artery, which was also followed along its entire course. Variations in the origin and branching pattern were observed.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMorphometric Evaluation\u003c/h3\u003e\n\u003cp\u003eThe following measurements were taken on both right and left limbs using Vernier calipers.\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eThe length of the dorsalis pedis artery, measured from an imaginary line connecting the medial and lateral malleoli to the first intermetatarsal space, as illustrated in (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe length of the arcuate artery.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe distance from the origin of the dorsalis pedis artery to the origin of the arcuate artery, as shown in (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eThe distance of the dorsalis pedis artery from the medial and lateral malleoli.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eDescriptive statistics were performed for the morphometric data.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eHistological Evaluation\u003c/h3\u003e\n\u003cp\u003eTen specimens were processed for histological examination to analyze the normal arterial wall architecture and identify any pathological changes. Histological processing and analysis are labor-intensive and resource-demanding, so a representative number of specimens was deemed sufficient to provide qualitative insights into the normal histology of the dorsalis pedis artery without compromising study feasibility. This smaller number balances thorough analysis with practical constraints of time and resources.\u003c/p\u003e\u003cp\u003eA segment of the dorsalis pedis artery was harvested from the dorsum of the foot, just distal to the mid-malleolar point, during routine cadaveric dissection for undergraduate teaching. The samples were dehydrated using graded alcohol concentrations (50%, 70%, 90%, and 100%), cleared in xylene, and embedded in paraffin wax. Serial sections of 5 \u0026micro;m thickness were prepared using a rotary microtome and mounted on glass slides. The slides were stained with hematoxylin and eosin (H\u0026amp;E) and examined under a microscope (Olympus CX 41) equipped with a U-TV1X-2 camera (Tokyo, Japan) for detailed photographic documentation.\u003c/p\u003e"},{"header":"Result","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eMorphometric Analysis\u003c/h2\u003e\u003cp\u003eDescriptive statistics of the dorsalis pedis artery (DPA) parameters are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean length of the dorsalis pedis artery was 7.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53 cm on the right leg and 8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02 cm on the left leg. The arcuate artery measured 4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82 cm on the right and 4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91 cm on the left. The length of the arcuate artery from the origin of the DPA was 4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42 cm on the right side and 4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11 cm on the left.\u003c/p\u003e\u003cp\u003eThe distance of the DPA from the medial malleolus was 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 cm on the right leg and 4.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02 cm on the left leg. The distance from the lateral malleolus was consistent at 5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 cm on both legs.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePresentation of Descriptive Statistics.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePARAMETERS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRight leg (cm)\u003c/p\u003e\u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLeft leg (cm) Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of dorsalis pedis artery\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of Arcuate artery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLength of Arcuate artery from origin of DPA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance of DPA from medial malleolus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistance of DPA from lateral malleolus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eVariations\u003c/h2\u003e\u003cp\u003eIn the present study, five distinct patterns of the dorsalis pedis artery and its branches were observed:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eType 1 (92% cases)\u003c/b\u003e: The anterior tibial artery continued as the dorsalis pedis artery with a typical course and branching pattern (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eType 2 (2% cases)\u003c/b\u003e: The anterior tibial artery bifurcated into the dorsalis pedis artery and lateral tarsal artery. The DPA extended to the first intermetatarsal space, giving off the first dorsal metatarsal artery and deep plantar artery. The DPA also gave the second DMA, while the lateral tarsal artery supplied the third and fourth DMA. Notably, the arcuate artery was absent in this type (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eType 3 (2% cases)\u003c/b\u003e: Similar bifurcation of the anterior tibial artery into DPA and lateral tarsal artery was observed. The DPA supplied the first DMAand deep plantar arteries. The lateral tarsal artery divided into medial and lateral branches; the medial branch formed the arcuate artery, which gave rise to the second, third, and fourth DMA. The lateral branch supplied the upper lateral foot. Second DMA dipped into the sole. There was no communication between the first and second DMA(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eType 4 (2% cases)\u003c/b\u003e: The DPA gave off medial and lateral malleolar arteries. Distal to the lateral malleolar artery, the DPA gave the lateral tarsal artery, and further distal, a recurrent artery arose to join the lateral tarsal artery forming a U-shaped loop. This recurrent artery gave rise to the fourth DMA. The DPA continued to the first intermetatarsal space, giving the first dorsal metatarsal and deep plantar arteries. The arcuate artery arose near the metatarsal heads, supplying the second and third DMA. (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003eType 5 (2% cases)\u003c/b\u003e: The anterior tibial artery divided into the DPA and lateral tarsal artery (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eA\u0026amp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eB). The DPA reached the first intermetatarsal space, giving two DMA and the deep plantar artery (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eC\u0026amp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eD). The second and fourth DMA originated from the plantar arch and were not branches of the DPA or lateral tarsal artery (Figs.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eA\u0026amp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003eB). The lateral tarsal artery supplied the third DMA, which gave two branches entering the sole (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eHistology\u003c/h3\u003e\n\u003cp\u003eOut of ten tissue specimens examined, only one showed a normal histological structure with intact tunica intima, media, adventitia, and internal and external elastic lamina, without any pathological features (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eOne specimen revealed duplication of the internal elastic lamina, visible as split layers (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003eA\u0026amp;B).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThree specimens showed intimal thickening with luminal occlusion due to plaque formation and disruption of the IEL (Fig.\u0026nbsp;11).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFig .11. Showing Occlusion of lumen with plaque. T.I- tunica intima, T.M- tunica media, T.A- tunica adventitia.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eVariations in arteries and their abnormal courses are closely associated with developmental processes. During the 4th week of embryogenesis, small vascular channels arise from blood islands and coalesce to form a continuous primitive network. From this network, buds emerge, canalize, and form new blood vessels and interconnect with neighboring vessels to establish a closed vascular network. As development progresses, certain channels enlarge while others regress, depending on functional dominance. This selective persistence and regression lead to differences in the origin and course of arteries, and the dorsalis pedis artery is particularly well known for such variations [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSeveral previous studies observed various types of variations in the branching pattern of the DPA, which include:\u003c/p\u003e\u003cp\u003eType A \u0026ndash; standard vascular pattern of DPA;\u003c/p\u003e\u003cp\u003eType B \u0026ndash; absence of DPA;\u003c/p\u003e\u003cp\u003eType C \u0026ndash; absence of arcuate artery;\u003c/p\u003e\u003cp\u003eType D \u0026ndash; arcuate artery absence with variations in number of lateral tarsal arteries;\u003c/p\u003e\u003cp\u003eType E \u0026ndash; variation in origin of the second dorsal metatarsal artery;\u003c/p\u003e\u003cp\u003eType F \u0026ndash; variation in origin of DPA and lateral tarsal arteries;\u003c/p\u003e\u003cp\u003eType G \u0026ndash; poorly formed DPA and lateral tarsal arteries;\u003c/p\u003e\u003cp\u003eType H \u0026ndash; arcuate artery forming U-shaped loop and double DPA (anterior tibial artery divides into two DPAs) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the present study, the standard pattern of the dorsalis pedis artery (DPA), characterized by the continuation of the anterior tibial artery as the DPA with its typical course and branching, was observed in 92% of cases, while variations accounted for 8%.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eType-1:\u003c/h2\u003e\u003cp\u003eA comparison of the Type-1 standard pattern from the current study with previous reports is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eType-2:\u003c/h2\u003e\u003cp\u003eLuckrajh et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and Rajeshwari et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] reported Type-2 variations in 7.5% and 2.38% of their respective samples, where the DPA gave rise to the 1st and 2nd DMA, while the 3rd and 4th arose from the lateral tarsal artery. In our study, a similar pattern was observed in 2% of cases.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eType-3:\u003c/h2\u003e\u003cp\u003eAwari \u0026amp; Vatsalaswamy et al. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] documented that the DPA gave rise only to the 1st dorsal metatarsal artery, with the 2nd, 3rd, and 4th DMA arising from the lateral tarsal artery in 40% of specimens. Rajeshwari et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] reported similar findings in 10% of cases. Other studies by Dilandro et al. [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], Vijayalakshmi et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], Kumari \u0026amp; Bharti et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and Luckrajh et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] noted comparable variations ranging from 5% to 6%. Our study observed this pattern in 2% of cases.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eType-4:\u003c/h2\u003e\u003cp\u003eLuckrajh et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and Rajeshwari et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] reported the presence of both proximal and distal lateral tarsal arteries forming a loop that gave rise to the 2nd, 3rd, and 4th DMA in 5% and 2.8% of cases, respectively. Additionally, Luckrajh et al. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] described a U-shaped loop with a recurrent artery connecting the proximal and distal lateral tarsal arteries in 2.5% of cases. In our study, 2% of cases demonstrated the DPA giving rise to the lateral tarsal artery, which formed a U-shaped loop with a recurrent artery. This recurrent artery gave rise to the 4th DMA, while the DPA itself gave rise to the 1st DMA and the arcuate artery. The arcuate artery then gave rise to the 2nd and 3rd DMA.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eType-5:\u003c/h2\u003e\u003cp\u003eHemamalini et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] reported that the 2nd, 3rd, and 4th DMA arose from the plantar arch in 8% of cases. In contrast, our study observed that the 2nd and 4th DMA arose from the plantar arch, the 1st from the DPA, and the 3rd from the lateral tarsal artery.\u003c/p\u003e\u003cp\u003eVazquez et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] documented that in 1.3% of cases, the perforating branch of the fibular artery replaced the course of the DPA. However, in the present study, the anterior tibial artery continued as the DPA in all specimens.\u003c/p\u003e\u003cp\u003eYamada et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and Reich et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] reported the absence of DPA in 6.7% and 14.2% of cases, respectively. Ntuli et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] reported 6.06%, where dorsal metatarsal arteries were given by the plantar arteries. Conversely, in our study, the DPA was present in all cases.\u003c/p\u003e\u003cp\u003eLee et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] reported that the first dorsal metatarsal artery originated from DPA in 90.6% of cases and from the lateral tarsal artery in 9.4%. In our study, the first DMA consistently originated from the DPA in all specimens.\u003c/p\u003e\u003cp\u003eHemamalini et al. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] found trifurcation of DPA, which was not found in our study. Comparison of standard patterns and variations of the Arcuate artery and DPA with other authors is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparative Analysis of the Standard Anatomy and Variations of the Dorsalis Pedis Artery and Arcuate Artery in Relation to Previous Studies\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAUTHORS\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSTANDARD PATTERN\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eABSENCE OF ARCUATE ARTERY\u003c/p\u003e\u003cp\u003ef arcuate artery\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eABSENCE OF DPA\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRajeshwari et al [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54.76%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.52\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVazquez et al [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReich et al[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLee et al. [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e90.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNtuli et al [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36.4%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15.2%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVijayalakshmi et al [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e56%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGupta et al [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresent study\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e92%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN/A\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe morphometric parameters obtained in this study, such as artery length and malleolar distances, are generally consistent with previous findings, although notable population-specific variations were observed. These measurements are critical for accurate clinical localization of the artery during pulse examination and invasive interventions.\u003c/p\u003e\u003cp\u003eChandini Gupta et al [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] reported 3% of absence of arcuate artery and the authors stated that DPA is not always at mid-malleolar point on the basis of measurement they got. They measured the mean distance of DPA from medial malleolus, which was 3.9cm, and from the lateral malleolus which was 6cm. In comparison, our study reported the following measurements: on the right side, the DPA was located at an average distance of 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 cm from the medial malleolus and 5.5 cm from the lateral malleolus; on the left side, the distances were 4.01\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02 cm from the medial malleolus and 5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 cm from the lateral malleolus. Additionally, Gupta et al. observed an average DPA length of 7.8 cm, while our findings showed an average length of 7.53 cm. Furthermore, our study reported a 4% absence rate of the arcuate artery.\u003c/p\u003e\u003cp\u003eThunyacharoen et al [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] reported that the mean length of DPA in right side is 11.96\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4 and in left side it is 12.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7. We reported average length in right side as 7.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53 and in left side as 8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02 in our study. They also reported the distances of the DPA of the right leg to the lateral malleolus and medial malleolus were 5.15\u0026thinsp;\u0026plusmn;\u0026thinsp;6.30 and 4.09\u0026thinsp;\u0026plusmn;\u0026thinsp;7.3 and the distances of the DPA of the left leg to the lateral malleolus and medial malleolus were 5.13\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0 and 4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1respectively. We reported average distance of DPA from lateral malleolus and medial malleolus 3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 and 5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 in right leg and 5.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.52 in left leg in our study.\u003c/p\u003e\u003cp\u003eThe histological findings are consistent with the classical characterization of M\u0026ouml;nckeberg\u0026rsquo;s sclerosis, a form of medial arterial calcification first described by M\u0026ouml;nckeberg in 1903. He observed fine calcium granules localized along the elastic lamina, occurring without extensive calcification of the arterial media.\u003c/p\u003e\u003cp\u003eOut of 10 DPA specimens, 6 showed the basophilic deposits suggestive of calcification with intimal thickening and calcium deposits extended to involve the internal elastic lamina (IEL) in 3 tissue specimens.\u003c/p\u003e\u003cp\u003eSince calcification in medial sclerosis (MS) can affect both the internal elastic lamina (IEL) and the media, different authors have proposed varied sites of origin. In their observations, calcium deposits were sometimes seen along the internal elastic lamina (IEL), while in other cases, it appeared as nodules or bands within the media. These nodules were often connected to calcified areas of the IEL in nearby planes, but when viewed alone, they could give the impression of calcification limited to the media [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eSome have suggested that the earliest changes occur in the IEL, beginning with loss of its normal undulation, altered staining features, and eventually disruption and calcification of the membrane. Others have described the process as starting within the media, related to degeneration of smooth muscle cells, possibly due to reduced blood supply in the mid-zone. Based on their observations, it has been proposed that calcification may originate at or just beneath the IEL, given its frequent involvement and close association with medial deposits [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eKlotz et al. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] and Abramson et al. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] observed early deposits at the IEL that extended into the media, which is consistent with the observations in our study, where the major part of the calcium deposits was within the internal elastic lamina and a smaller portion in the media.\u003c/p\u003e\u003cp\u003eSilbert et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] described calcium deposits in the connective tissue fibrils between smooth muscle cells that often disrupt the IEL, while the disruption of the internal elastic lamina by the calcium deposits was observed in our study.\u003c/p\u003e\u003cp\u003ePeery \u0026amp; Miller et al. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] reported that calcium deposits were predominantly located within the arterial media, often involving the internal elastic lamina (IEL). In our study of six specimens, IEL involvement was observed in three cases, whereas in the remaining three specimens, calcification was confined exclusively to the medial layer.\u003c/p\u003e\u003cp\u003eLachman et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] reported medial arterial calcification with sparing of both the internal and external elastic laminae in all examined specimens. In contrast, our study observed sparing of the internal elastic lamina in only three cases.\u003c/p\u003e\u003cp\u003eSilver et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] and Burke and Virmani et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] reported that calcium deposits may originate at the internal elastic lamina (IEL) and subsequently extend into the medial layer. This progression underscores the variability of the pathological process, a pattern that aligns with the findings observed in our study.\u003c/p\u003e\u003cp\u003eRobert G et al. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] reported that all specimens in their study exhibited calcium deposits involving the internal elastic lamina (IEL), whereas in our study, IEL involvement was observed in only three specimens.\u003c/p\u003e\u003cp\u003eTherefore, the integration of variations, morphometric, and histological data offers a comprehensive framework for elucidating the structure and pathology of the dorsalis pedis artery (DPA) in both normal and diseased states.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe dorsalis pedis artery is a critical vessel for assessing foot circulation, with its pulse typically palpable lateral to the extensor hallucis longus tendon. Knowledge of the variations in the origin and branching patterns of the DPA is essential for differentiating normal anatomical differences from pathological conditions such as aneurysms, deep vein thrombosis, and peripheral arterial diseases.\u003c/p\u003e\u003cp\u003eThe DPA also plays a vital role in ankle surgeries and revascularization procedures. Histological examination provides valuable insights into arterial wall changes, such as intimal thickening, medial calcification, and alterations in elastic laminae, aiding in the identification of vascular diseases including M\u0026ouml;nckeberg\u0026rsquo;s sclerosis. Together, anatomical and histological understanding enhances clinical assessment and surgical management of foot vascular conditions.\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eOnly 50 lower limbs from 25 cadavers were examined, which is a relatively small sample for generalizing findings, especially for anatomical variations that may have population-specific prevalence.\u003c/p\u003e\u003cp\u003eOnly ten histological specimens were examined from the 50 limbs studied. This small histological sample may not adequately represent the full spectrum of vascular pathology or normal variation in the population. Furthermore, histological analysis was limited to a single site (just distal to the mid-malleolar point), potentially missing regional variations along the length of the artery. Special stains, such as Von Kossa or Alizarin Red S, could be used to confirm the presence of calcium deposits in the tunica media.\u003c/p\u003e\u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDPA \u0026nbsp; \u0026nbsp; Dorsalis Pedis artery\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDMA \u0026nbsp; \u0026nbsp;Dorsal metatarsal artery\u003c/p\u003e\n\u003cp\u003eLTA \u0026nbsp; \u0026nbsp; Lateral tarsal artery\u003c/p\u003e\n\u003cp\u003ePAD \u0026nbsp; \u0026nbsp; Peripheral arterial disease\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eT.I \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Tunica intima\u003c/p\u003e\n\u003cp\u003eT.M \u0026nbsp; \u0026nbsp; Tunica media\u003c/p\u003e\n\u003cp\u003eT.A \u0026nbsp; \u0026nbsp; \u0026nbsp; Tunica adventitia\u003c/p\u003e\n\u003cp\u003eIEL \u0026nbsp; \u0026nbsp; \u0026nbsp;Internal elastic lamina\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;EEL \u0026nbsp; \u0026nbsp;External elastic lamina\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe informed written consent from the patients follows the tenets of the Declaration of Helsinki. The clearance was obtained from the Ethics Committee of Kasturba Medical College, Manipal (IEC2-725-2023). The consent was obtained during the body donation; therefore, individual consent was waived by the ethics committee of Kasturba Medical College.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e: not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest. All co-authors have seen and agree with the manuscript\u0026apos;s contents. We certify that the submission is original work and is not under review at any other publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAbramson DI, Dobrin PB (1984) Blood Vessels and Lymphatics in Organ Systems. Orlando (FL): Academic Press\u003c/li\u003e\n\u003cli\u003eAwari P, Vatsalaswamy P (2016) Anatomical variations in dorsalis pedis artery and its branches with clinical correlations. Int J Curr Res 8(10):40692\u0026ndash;40696 http://www.journalcra.com/sites/default/files/issue-pdf/17661.pdf\u003c/li\u003e\n\u003cli\u003eBurke A, Virmani R (2001) Temporal artery biopsy of giant cell arteritis: case reviews. Pathol Case Rev 6:265\u0026ndash;273\u003c/li\u003e\n\u003cli\u003eChristoforou P, Asaloumidis N, Katseni K, Kotsis T (2016) Dorsalis pedis artery aneurysm: a case report and review of the literature. Ann Vasc Surg 34:271.e1\u0026ndash;271.e4. doi:10.1016/j.avsg.2016.01.009\u003c/li\u003e\n\u003cli\u003eDiLandro AC, Lilja EC, Lepore FL (2001) The prevalence of arcuate artery: a cadaveric study of 72 feet. J Am Podiatr Med Assoc 91(6):300\u0026ndash;305. doi:10.7547/87507315-91-6-300\u003c/li\u003e\n\u003cli\u003eGupta C, Kumar R, Palimar V, Kalthur SG (2018) Morphometric study of dorsalis pedis artery and variation in its branching pattern: a cadaveric study. Int Med J Malaysia 17(1):19\u0026ndash;22. doi:10.31436/imjm.v17i1.306\u003c/li\u003e\n\u003cli\u003eHemamalini, Manjunatha HN (2021) Variations in the origin, course and branching pattern of dorsalis pedis artery with clinical significance. Sci Rep 11:1448. doi:10.1038/s41598-020-80956-0\u003c/li\u003e\n\u003cli\u003eKlotz O (1916) Fracture of arteries. J Med Res 34(3):495\u0026ndash;507. https://pmc.ncbi.nlm.nih.gov/articles/PMC2083929/\u003c/li\u003e\n\u003cli\u003eKumar N, Panchakshari K, Srikanth K (2023) Dorsalis pedis artery variations: a meta-analysis study. J Acad Med Pharm 5(1):50\u0026ndash;54. doi:10.47009/jamp.2023.5.1.13\u003c/li\u003e\n\u003cli\u003eKumari M, Bharti JP (2016) Anatomic variations of arteria dorsalis pedis: a cadaveric study on 40 dissected lower limbs with clinical correlations. Int J Contemp Med Res 3(6):1575\u0026ndash;1576 https://www.ijcmr.com/uploads/7/7/4/6/77464738/ijcmr_713_june_13.pdf.\u003c/li\u003e\n\u003cli\u003eLachman AS, Spray TL, Kerwin DM, Shugoll GI, Roberts WC (1977) Medial calcinosis of Monckeberg: a review of the problem and a description of a patient with involvement of peripheral, visceral and coronary arteries. Am J Med 63:615\u0026ndash;622\u003c/li\u003e\n\u003cli\u003eLee JH, Dauber W (1997) Anatomical study of dorsalis pedis artery and first dorsal metatarsal artery. Ann Plast Surg 38(1):50\u0026ndash;55. doi:10.1097/00000637-199701000-00009\u003c/li\u003e\n\u003cli\u003eLuckrajh JS, Lazarus L, Naidoo N, Rennie C, Satyapal KS (2018) Anatomy of the dorsalis pedis artery. Int J Morphol 36(2):730\u0026ndash;736. doi:10.4067/S0717-95022018000200730\u003c/li\u003e\n\u003cli\u003eMicheletti RG, Fishbein GA, Currier JS, Fishbein MC (2008) M\u0026ouml;nckeberg sclerosis revisited: a clarification of the histologic definition of M\u0026ouml;nckeberg sclerosis. Arch Pathol Lab Med 132(1):43\u0026ndash;47. doi:10.5858/2008-132-43-MSRACO\u003c/li\u003e\n\u003cli\u003eNakamura S, Ishibashi-Ueda H, Niizuma S, Yoshihara F, Horio T, Kawano Y (2009) Coronary calcification in patients with chronic kidney disease and coronary artery disease. Clin J Am Soc Nephrol 4(12):1892\u0026ndash;1900. doi:10.2215/CJN.04320709\u003c/li\u003e\n\u003cli\u003eNtuli S, Nalla S, Kiter A (2018) Anatomical variation of the dorsalis pedis artery in a South African population: a cadaveric study. Foot (Edinb) 35:16\u0026ndash;27. doi:10.1016/j.foot.2018.01.002\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Hare AM, Glidden DV, Fox CS, Hsu CY (2004) High prevalence of peripheral arterial disease in persons with renal insufficiency: results from the National Health and Nutrition Examination Survey 1999\u0026ndash;2000. Circulation 109(3):320\u0026ndash;323 doi:10.1161/01.CIR.0000114519.75433.DD\u003c/li\u003e\n\u003cli\u003ePeery TM, Miller FN Jr (1971) Pathology: A Dynamic Introduction to Medicine and Surgery. 2nd ed. Boston (MA): Little, Brown\u003c/li\u003e\n\u003cli\u003ePernes JM, et al. (2015) Infrapopliteal arterial recanalization: a true advance for limb salvage in diabetics. Diagn Interv Imaging 96(4):423\u0026ndash;434. doi:10.1016/j.diii.2014.11.018\u003c/li\u003e\n\u003cli\u003eRajeshwari MS, Roshankumar BN, Vijayakumar (2013) An anatomical study on dorsalis pedis artery. Int J Anat Res 1(2):8892.http://www.ijmhr.org/ijar_articles_vol1_02/220.pdf\u003c/li\u003e\n\u003cli\u003eReich RS (1934) The pulses of the foot: their value in the diagnosis of peripheral circulatory disease. Ann Surg 99(4):613\u0026ndash;622. doi:10.1097/00000658-193404000-00008\u003c/li\u003e\n\u003cli\u003eSilbert SLH (1945) Moenckeberg\u0026rsquo;s sclerosis: a clinical entity. J Mt Sinai Hosp NY 12\u0026ndash;13:689\u0026ndash;700\u003c/li\u003e\n\u003cli\u003eSilver M, Gotlieb A, Schoen FJ (2001) Cardiovascular Pathology. 3rd ed. New York (NY): Churchill Livingstone\u003c/li\u003e\n\u003cli\u003eStandring S, editor (2016) Gray\u0026rsquo;s Anatomy: The Anatomical Basis of Clinical Practice. 41st ed. London: Elsevier. p. 624\u003c/li\u003e\n\u003cli\u003eThunyacharoen S, Mahakkanukrauh C, Pattayakornkul N, Meetham K, Charumporn T, Mahakkanukrauh P (2021) Anatomical variations of the dorsalis pedis artery in a Thai population. Int J Morphol 40(1):137\u0026ndash;142. doi:10.4067/S0717-95022022000100137\u003c/li\u003e\n\u003cli\u003eV\u0026aacute;zquez T, Rodr\u0026iacute;guez-Niedenf\u0026uuml;hr M, Parkin I, Viejo F, Sa\u0026ntilde;udo JR (2006) Anatomic study of blood supply of the dorsum of the foot and ankle. Arthroscopy 22(3):290.e1\u0026ndash;290.e5. doi:10.1016/j.arthro.2005.12.027\u003c/li\u003e\n\u003cli\u003eVijayalakshmi S, Raghunath G, Shenoy V (2011) Anatomical study of dorsalis pedis artery and its clinical correlations. J Clin Diagn Res 5(2):287\u0026ndash;290. doi:10.7860/JCDR/2011/.1251\u003c/li\u003e\n\u003cli\u003eWang L, Fu J, Li M, Han D, Yang L (2013) Repair of hand defects by transfer of free tissue flaps from toes. Arch Orthop Trauma Surg 133(1):141\u0026ndash;146. doi:10.1007/s00402-012-1637-5\u003c/li\u003e\n\u003cli\u003eYamada T, Gloviczki P, Bower TC, Naessens JM, Carmichael SW (1993) Variations of the arterial anatomy of the foot. Am J Surg 166(2):130\u0026ndash;135. doi:10.1016/S0002-9610(05)80303-0\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dorsalis pedis artery, Arcuate artery, Ankle surgeries, Peripheral arterial diseases, Basophilic calcification","lastPublishedDoi":"10.21203/rs.3.rs-7813762/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7813762/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe dorsalis pedis artery (DPA), the primary arterial supply to the dorsum of the foot, is a critical landmark in clinical and surgical procedures. While its morphometry and variations has been well studied, limited data exist on its histological characteristics. This study aimed to analyze the histology, morphometry and anatomical variations of the DPA.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFifty lower limbs from 25 cadavers were examined at the Department of Anatomy, Kasturba Medical College, Manipal, following IEC approval. The length of the DPA and arcuate artery was measured. The distance of the arcuate artery from the origin of the dorsalis pedis artery and the distance of DPA from the medial and lateral malleolus were also measured. A segment distal to the mid-malleolar point was harvested for histological analysis. Anatomical variations were documented.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe mean DPA length was 7.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53 cm (right) and 8.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.02 cm (left). The arcuate artery measured 4.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.82 cm (right) and 4.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.91 cm (left), arising approximately 4.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42 cm and 4.6\u0026thinsp;\u0026plusmn;\u0026thinsp;1.11 cm from the DPA origin on the right and left sides, respectively. Four variations in the emergence of dorsal metatarsal arteries were observed. Histological findings included basophilic calcification of the tunica media in six specimens\u0026mdash;three with additional involvement of the internal elastic lamina\u0026mdash;and thrombotic occlusion with tunica intima disruption in three cases.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDetailed knowledge of the DPA\u0026rsquo;s morphometry and histology enhances the precision of surgical interventions and supports early diagnosis of peripheral vascular pathologies.\u003c/p\u003e","manuscriptTitle":"Morphometric Analysis, Anatomical Variations and Histological Evaluation of the Dorsalis Pedis Artery in Human Cadavers: Implications for Clinical and Surgical Practice","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-27 14:33:15","doi":"10.21203/rs.3.rs-7813762/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"866b60f4-a859-4797-a962-c64db5a1ddad","owner":[],"postedDate":"October 27th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-04T11:38:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-27 14:33:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7813762","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7813762","identity":"rs-7813762","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}