Vessels

The femoral artery (Fig. 153) can be felt pulsating at the mid-inguinal point, half-way between the anterior superior iliac spine and the pubic symph-ysis. The upper two-thirds of a line joining this point to the adductor tubercle, with the hip somewhat flexed and externally rotated, accurately defines the surface markings of this vessel. A finger on the femoral pulse lies directly over the head of the femur, immediately lateral to the femoral vein

Adductor Hallucis Tibialis Anterior

Fig. 151 The structures passing over the dorsum of the ankle.

Fig. 151 The structures passing over the dorsum of the ankle.

Abductor hallucis Fig. 152 The structures passing behind the medial malleolus.

Mid Inguinal Point
Fig. 153 The surface markings of the femoral artery; the upper two-thirds of a line joining the mid-inguinal point (halfway between the anterior superior iliac spine and the symphysis pubis), to the adductor tubercle.

(hence the termination of the great saphenous vein) and a finger's breadth medial to the femoral nerve.

The pulse of the popliteal artery is often not easy to detect. It is most readily felt with the patient prone, his knee flexed and his muscles relaxed by resting the leg on the examiner's arm. The pulse is sought by firm pressure downwards against the popliteal fossa of the femur.

The pulse of dorsalis pedis (Fig. 151) is felt between the tendons of extensor hallucis longus and extensor digitorum on the dorsum of the foot—it is absent in about 2% of normal subjects. The posterior tibial artery (Fig. 152) may be felt a finger's breadth below and behind the medial malleolus. In about 1% of healthy subjects this artery is replaced by the peroneal artery.

The absence of one or both pulses at the ankle is not, therefore, in itself diagnostic of vascular disease.

The small (or short) saphenous vein commences as a continuation of the veins on the lateral side of the dorsum of the foot, runs proximally behind the lateral malleolus, and terminates by draining into the popliteal vein

Saphenous Vein Anatomy

_ Great saphenous vein

Medial malleolus

_ Great saphenous vein

Fig. 154 The relationship of the great (long) saphenous vein to the medial malleolus.

behind the knee. The great (or long) saphenous vein arises from the medial side of the dorsal network of veins, passes upwards in front of the medial malleolus, with the saphenous nerve anterior to it, to enter the femoral vein in the groin, one inch below the inguinal ligament and immediately medial to the femoral pulse.

These veins are readily studied in any patient with extensive varicose veins and are usually visible, in their lower part, in the thin normal subject on standing. (The word 'saphenous' is derived from the Greek for 'clear'.)

From the practical point of view, the position of the long saphenous vein immediately in front of the medial malleolus is perhaps the most important single anatomical relationship; no matter how collapsed or obese, or how young and tiny the patient, the vein can be relied upon to be available at this site when urgently required for transfusion purposes (Fig. 154).

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