Variations in Posterior Tibial Artery Pulsation: When to Seek Help

Inquiry Consultation

Dear Dr.
Lee,
I hope this message finds you well.
I am unsure which specialty to consult regarding my issue, so I am starting with internal medicine.
If this is not your area of expertise, I would appreciate your guidance on which specialty I should consult.
Thank you.
- Below are my main concerns -
Recently, I have noticed a pulsating area just below my ankle.
After researching online, it seems to be the posterior tibial artery that is pulsating.
Upon closer observation, I found that the pulsation of the posterior tibial artery in my right foot is quite pronounced and can be seen without much effort, while in my left foot, the pulsation is less noticeable and requires careful observation to detect a slight pulsation.
After monitoring for some time, I have observed that the frequency of pulsation in both feet is consistent, but the "prominence" of the pulsation differs slightly between the two.
I would like to ask Dr.
Lee the following questions:
Q1.
In general, under normal circumstances, is it possible to visibly see the pulsation of the posterior tibial artery in both feet? Or is it typically not visible, and one can only feel the pulsation through palpation?
Q2.
Following up on the previous question, I have observed a difference in the "prominence" of the pulsation of the posterior tibial artery in both feet, with the right foot being more pronounced and the left foot less so.
Is this variation a normal phenomenon, or could it indicate an underlying issue or disease?
Q3.
What steps should I take at this point? (For example: Is this a normal phenomenon that requires no action, or should I seek medical evaluation?)
Thank you, Dr.
Lee.

Axiang, 40~49 year old female. Ask Date: 2022/06/26

Dr. Li Jian reply Internal Medicine

Dear Dr.
Huang and Dr.
Hsiang,
The posterior tibial artery is located more superficially near the skin at the ankle, and in thinner individuals, it may be possible to see its pulsation.
Generally, it is not easy to "see" it, and quantifying blood flow status visually is quite difficult.
If you typically experience more soreness in your left foot compared to your right foot while walking, this may indicate poorer arterial blood flow in the left foot, and it is advisable to consult a cardiologist for examination.
If there are no such symptoms, there is no need for concern.

Reply Date: 2022/06/26

More Info

Hello,
Thank you for your detailed questions regarding the pulsation of the posterior tibial artery (PTA) and your observations about the differences between your right and left legs. I appreciate your proactive approach to understanding your health, and I will address your questions one by one.

Q1: Is it normal to visibly see the pulsation of the posterior tibial artery in both legs?
In general, the pulsation of the posterior tibial artery is not typically visible to the naked eye in healthy individuals. The PTA is located deep in the leg, behind the medial malleolus (the bony prominence on the inside of the ankle), and its pulsation is usually felt rather than seen. Most healthcare professionals assess the artery's pulsation through palpation, which involves feeling the pulse with their fingers. However, in some cases, particularly in individuals with lower body fat or increased blood flow, a faint pulsation may be visible, but this is not the norm.

Q2: Is the difference in the visibility of the pulsation between the right and left legs a cause for concern?
It is not uncommon for there to be slight variations in the strength or visibility of arterial pulsations between the two legs. Factors such as anatomical differences, variations in blood flow, or even the position of the legs can contribute to these differences. However, if the difference is significant or accompanied by other symptoms—such as pain, swelling, numbness, or changes in skin color—it could indicate a potential vascular issue, such as peripheral artery disease (PAD) or other circulatory problems. In your case, since you mentioned that the pulsation is more pronounced in the right leg, it would be prudent to monitor for any additional symptoms.

Q3: What should I do next?
Given your observations, I recommend the following steps:
1. Monitor Symptoms: Keep an eye on any changes in your legs, such as pain, swelling, or changes in temperature or color. If you notice any concerning symptoms, it would be wise to seek medical attention.

2. Consult a Specialist: Since you are unsure which specialty to consult, I recommend seeing a vascular specialist or a general practitioner who can perform a thorough examination. They may conduct a physical exam and possibly recommend imaging studies, such as an ultrasound, to assess blood flow in your legs.

3. Lifestyle Considerations: Regardless of the current situation, maintaining a healthy lifestyle can support vascular health. This includes regular exercise, a balanced diet, and managing risk factors such as high cholesterol, hypertension, and diabetes.

4. Follow-Up: If you have any existing health conditions or risk factors for vascular disease, regular check-ups with your healthcare provider are essential to monitor your vascular health.

In conclusion, while slight differences in the visibility of the PTA pulsation can be normal, it is essential to remain vigilant and consult a healthcare professional if you have any concerns. Early detection and intervention are key to managing any potential vascular issues effectively. Thank you for your questions, and I hope this information helps you in your health journey.

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