Source Arteries Blood supply of foot comes from three primary source arteries Peroneal (fibular) artery Posterior tibial artery Anterior tibial artery Peroneal (Fibular) Artery Origin arises from the posterior tibial artery approximately 2.5 cm from its origin Course in leg pierces interosseous membrane ~ 5 cm above lateral malleolus as perforating branch and communicates with the anterior lateral malleolar artery then passes down anterior to tibiofibular syndesmosis to anastomose with lateral tarsal artery supplies the soleus, tibialis posterior, flexor hallicus longus, and peroneal muscles along its course Branches at ankle posterior lateral malleolar artery communicating branch Branches in foot lateral calcaneal branch terminal branch of the peroneal artery provides perfusion to the lateral flap associated with a standard extensile approach to the calcaneus Posterior Tibial Artery Origin largest of the two terminal branches of the popliteal artery its most proximal part is referred to as the tibioperoneal trunk Course in leg it passes between the superficial and deep muscles of the posterior compartment of the lower leg as it courses down the lower leg it becomes more medial and is palpable behind the medial malleolus Branches at the ankle posterior medial malleolar artery communicating branch artery of tarsal canal dominant blood supply to the talar body Branches in foot beneath sustentaculum posterior tibial artery bifurcates into lateral plantar arteries branches medial calcaneal branch (first branch) is the major vascular supply to the heel pad heel pad avulsions are severe injuries associated with high-energy trauma and often carry a poor prognosis because of the potential for heel pad necrosis branches to abductor digiti minimi (second branch) digital branch to fifth toe (third branch) terminal branch plantar branch (see below) medial plantar arteries branches terminal branch anastomoses with the first dorsal metatarsal branch of the dorsalis pedis artery superficial digital branches join plantar metatarsal arteries of first three intermetatarsal spaces Anterior Tibial Artery Origin the other, smaller, terminal branch of the popliteal artery Course in leg descends anterior to the interosseous membrane and supplies the muscles of the anterior compartment of the lower leg it becomes superficial at the ankle midway between the malleoli supplies muscles of the anterior compartement of the lower leg Branches at ankle anterior medial malleolar artery anterior lateral malleolar artery Branches in foot dorsalis pedis artery a continuation of the anterior tibial artery in the foot palpable over the dorsum of the foot just lateral to the extensor hallicus longus tendon branches arcuate (see below) lateral tarsal medial tarsal arteries terminates at the first intermetatarsal space into first dorsal metatarsal artery deep plantar arch (see below) Blood Supply to Distal Foot & Toes Plantar arch origin forms from the anastomosis of the lateral plantar artery and the dorsalis pedis artery provides blood supply to plantar foot and toes branches plantar digital arteries plantar metatarsal arteries Arcuate artery is a vascular arch that runs in the dorsal midfoot deep to the extensor tendons gives off dorsal metatarsal arteries that run in the 2nd, 3rd and 4th intermetatarsal spaces. Vein System of the Foot The dorsal venous arch drains into the greater and lesser saphenous venous systems