BACKGROUND: The deep plantar (D-PL) artery originates from the dorsalis pedis artery in the proximal first intermetatarsal space, an area where many procedures are performed to address deformity, traumatic injury and infection. The potential risk to injury of the D-PL artery is concerning. The D-PL artery provides vascular contribution to the base of the first metatarsal and forms the D-PL arterial arch with the lateral plantar artery. METHODS: In an effort to improve our understanding of the positional relationship of the D-PL artery to the first metatarsal, dissections were performed on 43 embalmed cadaver feet to measure the location of the D-PL artery with respect to the base of the first metatarsal. Images of the dissected specimens were digitally acquired and saved for measurement using in-house written software. The mean, standard deviation and 95% confidence intervals were calculated for all measurement parameters. RESULTS: We found that the origin of the D-PL artery was located at 11.5 ± 3.9 mm (95% CI: 4.5 - 24.7 mm) distal to the first metatarsal base and 18.6% ± 6.5% (95% CI: 8.1% to 43.4%) its length in reference to the proximal base. The average inter-rater reliability across all measurements was 0.945. CONCLUSIONS: Our study helps to clarify the anatomic location of the D-PL artery by providing parameters to aid the surgeon when performing procedures in the proximal first intermetatarsal space. Care must be taken when performing procedures in the region to avoid unintended vascular injury to the D-PL artery.

BACKGROUND: A survey of pathology present in the subtalar joint by means of subtalar arthroscopy with anterolateral and middle portals has not been extensively explored in current literature. The focus of our study was to identify pathology in the subtalar joint at the time of subtalar joint arthroscopy using this approach. We also compare our arthroscopic findings to those reported in the literature. METHODS: We performed a retrospective review of 49 consecutive patients that had undergone subtalar arthroscopy. Data were obtained from intraoperative arthroscopic findings that were documented in the operative note or with arthroscopic photography. Additional procedures including ankle arthroscopy, lateral ankle stabilization and peroneal tendon repair were recorded. Descriptive statistics were calculated and reported. RESULTS: Subtalar arthroscopic examination revealed that all cases (100%) had intra-articular synovitis or adhesions present. Twenty-two cases (42%) demonstrated subtalar joint instability, seven cases (13%) had chondromalacia and 1 case (2%) had an exostosis present. These observations are consistent with other reported findings in the literature. CONCLUSIONS: This study found that the subtalar joint was most often affected by synovitis, adhesions and instability in patients with symptomatic pathologies requiring subtalar arthroscopy. There was a relatively low incidence of chondromalacia or exostosis formation in our survey.

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.