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We read with interest the article by Mowlavi et al and agree that the palpation of pedal pulses is a useful clinical tool.1 Therefore any attempt to standardise the technique of palpation must be applauded. Using the “navicular” method, the authors palpated 78% of pulses in a group of patients under the care of the surgical team. Unfortunately they do not describe the past medical history of this cohort. If their patients have no past medical history of peripheral vascular disease then their method of palpation is less sensitive than previous studies which detect the pulse in 86.2%–96.9% of healthy patients.2,3 It would have been useful to know the proportion of arteriopaths in their study. We routinely palpate the dorsalis pedis pulse on a line joining the midpoint of the malleoli to the first webspace. Although this involves soft tissue landmarks, it is nevertheless easy to identify and palpate the pulse on this line. The navicular, in contrast, is not an easy bone to palpate, especially in the oedematous or deformed foot. While they demonstrate a new landmark to readily palpate the dorsalis pedis pulse, we do not feel that they have demonstrated any improvement in either accuracy or ease of use compared with a more traditional landmark.
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