The first dorsal metatarsal artery arises from the dorsalis pedis at the first intermetatarsal space, supplying the dorsal surfaces of the great toe and medial second toe. It contributes to the hallux nail bed and the dorsal web space between the first and second toes.
The first dorsal metatarsal artery is the vascular pedicle for several dorsal foot flaps and great toe transfers in reconstructive surgery. Its presence and calibre are confirmed preoperatively with Doppler ultrasound or CTA. Hallux valgus correction osteotomies must avoid compromising this vessel to prevent great toe avascular necrosis.
Ischaemia of the great toe from first dorsal metatarsal artery injury during bunion surgery, presenting as hallux pallor or cyanosis requiring urgent surgical exploration.
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