The Venous Pump of the Human Foot—Preliminary Report

We have discovered a venous pump mechanism in the sole of the human foot that is able to return blood from the leg up into the abdomen with no assistance from muscular action. The veins of the sole of the foot have been regarded as insignificant from the pathological point of view1 and most anatomical descriptions refer merely to medial and lateral plantar arches although French anatomists have referred to the 'semelle veineux plantaire' or 'le reseau veineux plantaire profund'?the dense plexus or insole of veins or the deep plantar venous network2 but conventional anatomical diagrams bear little relation to the large calibre veins as demonstrated by orthostatic phlebography.3 If little interest has been shown in the venous anatomy of the foot, less has been shown in the physiology of venous return. Although surgeons have realised that squeezing the foot in the supine position increases flow in the normal femoral vein as judged by Doppler as does compression of calf or thigh; (this test is used to show patency or otherwise of the femoral veins). It has been vaguely assumed that some pump system exists activated probably by ankle or toe movements and rise in venous pressure on weight bearing has been recorded.4 It is surprising that there is so little basic knowledge of the vascular system of the foot particularly in view of the clinical importance of flat foot, and the plantar fasciitis-calcaneal spur syndrome. If little attention has been paid to anatomy and physiology of the veins of the foot, even less has been paid to the venous pathology. Morbid anatomists dissect the foot only when obviously diseased, in any case the present climate of opinion is opposed to such routine dissection since it could lead to accusations of unnecessary mutilation of the body. For this reason primary venous thrombosis has not been previously described. We studied the venous return of the normal foot of one of us (A. M.N.G.): contrast medium, Hexabrix (May & Baker Ltd), was injected into a vein on the dorsum of the foot while standing and weight bearing only on the other foot. Flow of contrast was recorded by video-phlebography and intermittent conventional radiography with synchronous observer commentary. The contrast agent was seen to flow via a channel between the second and third metatarsal bases and to pool in two deep medial plantar veins and in their more superficial tributaries, the most posterior …