DavisBL, KuznickiJ, PraveenSS, : Lower-extremity amputations in patients with diabetes: pre- and post-surgical decisions related to successful rehabilitation. Diabetes Metab Res Rev20: 45, 2004.10.1002/dmrr.445)| false
ShiE, JexM, PatelS, : Outcomes of wound healing and limb loss after transmetatarsal amputation in the presence of peripheral vascular disease. J Foot Ankle Surg58: 47, 2019.3058378110.1053/j.jfas.2018.07.004)| false
DillinghamTR, PezzinLE, ShoreAD: Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations. Arch Phys Med Rehabil86: 480, 2005.10.1016/j.apmr.2004.06.07215759232)| false
MuellerMJ, AllenBT, SinacoreDR: Incidence of skin breakdown and higher amputation after transmetatarsal amputation: implications for rehabilitation. Arch Phys Med Rehabil76: 50, 1995.10.1016/S0003-9993(95)80042-57811175)| false
O’BrienPJ, CoxMW, ShortellCK, : Risk factors for early failure of surgical amputations: an analysis of 8,878 isolated lower extremity amputation procedures. J Am Coll Surg216: 836, 2013.10.1016/j.jamcollsurg.2012.12.04123521969)| false
RiesZ, RungpraiC, HarpoleB, et al.: Incidence, risk factors, and causes for thirty-day unplanned readmissions following primary lower-extremity amputation in patients with diabetes. J Bone Joint Surg Am97: 1774, 2014.
RiesZ, RungpraiC, HarpoleB, : Incidence, risk factors, and causes for thirty-day unplanned readmissions following primary lower-extremity amputation in patients with diabetes. J Bone Joint Surg Am97: 1774, 2014.10.2106/JBJS.O.00449)| false
AttingerCE, EvansKK, BulanE, : Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization. Plast Reconstr Surg117: 261, 2006.10.1097/01.prs.0000222582.84385.54)| false
AttingerC, CooperP, BlumeP, et al.: The safest surgical incisions and amputations applying the angiosome principles and using the Doppler to assess the arterial-arterial connections of the foot and ankle. Foot Ankle Clin6: 745, 2001.
AttingerC, CooperP, BlumeP, : The safest surgical incisions and amputations applying the angiosome principles and using the Doppler to assess the arterial-arterial connections of the foot and ankle. Foot Ankle Clin6: 745, 2001.10.1016/S1083-7515(02)00012-812134581)| false
HigashimoriA, IidaO, YamauchiY, : Outcomes of one straight-line flow with and without pedal arch in patients with critical limb ischemia. Catheter Cardiovasc Interv87: 129, 2016.2648953110.1002/ccd.26164)| false
ManziM, FusaroM, CeccacciT, et al.: Clinical results of below-the knee intervention using pedal-plantar loop technique for the revascularization of foot arteries. J Cardiovasc Surg (Torino)50: 331, 2009.
ManziM, FusaroM, CeccacciT, : Clinical results of below-the knee intervention using pedal-plantar loop technique for the revascularization of foot arteries. J Cardiovasc Surg (Torino)50: 331, 2009.)| false
MeyerA, SchinzK, LangW, : Outcomes and influence of the pedal arch in below-the-knee angioplasty in patients with end-stage renal disease and critical limb ischemia. Ann Vasc Surg35: 121, 2016.10.1016/j.avsg.2016.01.03927238998)| false
MochizukiY, HoshinaK, ShigematsuK, : Distal bypass to a critically ischemic foot increases the skin perfusion pressure at the opposite site of the distal anastomosis. Vascular24: 361, 2016.2622352910.1177/1708538115597605)| false
PalenaLM, BroccoE, ManziM: The clinical utility of below-the-ankle angioplasty using “transmetatarsal artery access” in complex cases of CLI. Catheter Cardiovasc Interv83: 123, 2014.2369606910.1002/ccd.24992)| false
RashidH, SlimH, ZayedH, : The impact of arterial pedal arch quality and angiosome revascularization on foot tissue loss healing and infrapopliteal bypass outcome. J Vasc Surg57: 1219, 2013.2352327810.1016/j.jvs.2012.10.129)| false
CreechCL, ZinyembaP, ChoiET, et al.: Anatomic limitations of the transmetatarsal amputation with consideration of the deep plantar perforating branch of the dorsalis pedis artery. J Foot Ankle Surg57: 880, 2018.
CreechCL, ZinyembaP, ChoiET, : Anatomic limitations of the transmetatarsal amputation with consideration of the deep plantar perforating branch of the dorsalis pedis artery. J Foot Ankle Surg57: 880, 2018.2988032310.1053/j.jfas.2018.03.010)| false
Background: The deep plantar arterial arch (DPAA) is formed by an anastomosis between the deep plantar artery and the lateral plantar artery. The potential risk of injury to the DPAA is concerning when performing transmetatarsal amputations, and care must be taken to preserve the anatomy. We sought to determine the positional anatomy of the DPAA based on anatomical landmarks that could be easily identified and palpated during transmetatarsal amputation.
Methods: In an effort to improve our understanding of the positional relationship of the DPAA to the distal metatarsal parabola, dissections were performed on 45 cadaveric feet to measure the location of the DPAA with respect to the distal metatarsal epiphyses. Images of the dissected specimens were digitally acquired and saved for measurement using in-house–written software. The mean, SD, SEM, and 95% confidence interval were calculated for all of the measurement parameters and are reported on pooled data and by sex. An independent-samples t test was used to assess for sex differences. Interrater reliability of the measurements was estimated using the intraclass correlation coefficient.
Results: The origin of the DPAA was located a mean ± SD of 35.6 ± 3.9 mm (95% confidence interval, 34.5–36.8 mm) proximal to the perpendicular line connecting the first and fifth metatarsal heads. The average interrater reliability across all of the measurements was 0.921.
Conclusions: This study provides the positional relationship of the DPAA with respect to the distal metatarsal parabola. This method is easily reproducible and may assist the foot and ankle surgeon with surgical planning and approach when performing partial pedal amputation.
Corresponding author: James H. Whelan, DPM, Podiatry, Beloit Health System, 1905 E Huebbe Pkwy, Beloit, WI 53511. (E-mail: email@example.com).