In assessing distal circulation in a patient with a swollen deformed femur, which action should you perform?

• A. Palpate for a dorsalis pedis pulse.
• B. Ask the patient to wiggle his toes.
• C. Touch his foot with a blunt object.
• D. Assess the pulse behind the knee.

Answer: (A)

Checking distal circulation means confirming that blood is still reaching the area beyond the injury. In a swollen, deformed femur, you want evidence of arterial flow to the foot to assess how well the leg is perfused.

Palpating the dorsalis pedis pulse is the best way to gauge that distal perfusion. This pulse sits on the top of the foot and directly reflects arterial flow beyond the knee into the foot. If you can feel a strong dorsalis pedis pulse, it suggests the distal circulation is intact. If that pulse is weak or absent, it raises concern for compromised blood flow, which requires prompt attention and careful management.

The other actions don’t measure distal blood flow: asking the patient to wiggle his toes tests motor function, not circulation; touching the foot with a blunt object is a sensory check, not a perfusion check; and the pulse behind the knee is proximal to the injury and doesn’t reliably tell you about perfusion to the foot in this context.