Passive hallux adduction has been shown to decrease blood flow in the lateral plantar artery (LPA) in a non-weight-bearing condition. Further research in weight-bearing and shod conditions is necessary to explore relationships between altered blood flow and injury or tissue healing. However, measuring blood flow in a shod foot would require an alternate measurement location to accommodate footwear, such as the more proximal posterior tibial artery (PTA). PURPOSE: To determine changes in blood flow in the PTA and LPA subsequent to passive hallux adduction and to compare the observed changes between the two arteries. Second, to determine if measurement at the PTA is a viable surrogate for measurement at the LPA. METHODS: Forty-one subjects (21 males, 20 females) participated in this study (age 23.5 ± 4.5 years, body mass 72.6 ± 13.7 kg, and height 173.1 ± 10.2 cm). PTA and LPA vessel diameter and velocity were measured via doppler ultrasound (L8-18i transducer GE Logiq S8). LPA was imaged distal to the abductor hallucis and the PTA posterior to the medial malleolus. Each artery was measured for 120 s: 60 s at rest followed by 60 s of passive hallux adduction. PTA and LPA metrics were log transformed and compared using a two-way repeated measures ANOVA, then the log transformed data was assessed with paired t-tests and Bland-Altman plots (alpha = 0.05). RESULTS: There was an expected decrease in blood flow within each artery after passive hallux adduction (p < 0.001). The volume of blood flow differed between the arteries (p < .0001), but the change between baseline to first 5 cardiac cycles after hallux adduction was similar in each artery (p = 0.419). Bland-Altman analysis showed large spread limits of agreement, indicating the PTA underestimated or overestimated measurements at the LPA. CONCLUSIONS: These data suggest that PTA blood flow behaves in a similar manner as LPA blood flow in consequence to passive hallux adduction. There is no significant difference in the absolute change of blood flow during hallux adduction between the LPA and PTA. However, Bland-Altman analysis suggests that the PTA is not a direct surrogate for the LPA due to the large variance in flow between the arteries. Despite this, the PTA can still be a beneficial location of measurement for plantar blood flow. Some reasons are that the PTA has a larger diameter making it an easier artery to image and allows for further research implications due to its ease of access in more applicable circumstances, such as in a shod condition.



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Life Sciences; Exercise Sciences



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narrow shoes, footwear, compromised blood flow



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Life Sciences Commons