Plantar Flexion–Induced Entrapment of the Dorsalis Pedis Artery in a Teenaged Cross-Country Runner
| Autor: | Leighton T. McCabe, Max V. Wohlauer, Jason W Stoneback, William R. Hiatt, Mary K. Jesse, Jeniann A. Yi |
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| Rok vydání: | 2021 |
| Předmět: |
Tarsometatarsal joints
medicine.medical_specialty Decompression business.industry medicine.medical_treatment Tenotomy General Medicine 030204 cardiovascular system & hematology musculoskeletal system 030218 nuclear medicine & medical imaging Tendon Surgery 03 medical and health sciences Retinaculum 0302 clinical medicine medicine.anatomical_structure Tendon transfer Dorsalis pedis artery medicine.artery Medicine Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Annals of Vascular Surgery. 70:213-218 |
| ISSN: | 0890-5096 |
| Popis: | Background Symptomatic peripheral artery disease of the lower extremity rarely affects young adults and, when present, typically has a nonatherosclerotic etiology. Anatomical variants have manifested as symptomatic foot ischemia in four cases in the literature. We describe the case of a 17-year-old girl presenting with foot pain upon plantar flexion due to dynamic dorsalis pedis (DP) artery entrapment by fibrous bands and the extensor hallucis brevis (EHB) tendon. Methods The patient was a 17-year-old girl who presented with right foot pain upon plantar flexion, which resolved upon returning to the neutral position. The potential site of compression was identified on MRI where the DP artery ran deep to the EHB tendon near the first and second tarsometatarsal joints. On diagnostic arteriogram, there was notching of the dorsalis pedis over the talus bone. The dorsalis pedis Doppler signal was obliterated upon plantar flexion. A longitudinal incision was made over the artery in the area of compression. The flexor retinaculum was incised. Abnormal fibrous bands were identified, which were lysed anterior to the artery. The EHB tendon was released and transferred distally to the extensor hallucis longus tendon. Results A completion angiogram showed a persistently patent dorsalis pedis artery with plantar flexion. She was discharged one day postoperatively without issues. On follow-up, the patient was ambulatory with complete resolution of her pain. Arterial duplex demonstrated normal velocities through the dorsalis pedis in all positions. Conclusions Symptomatic peripheral artery disease is a rare presentation in young adults and is usually due to nonatherosclerotic pathophysiology. We present a rare case of dorsalis pedis artery entrapment syndrome. Given the mechanical nature of obstruction, surgical correction was an effective treatment. |
| Databáze: | OpenAIRE |
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