Updated: 6/7/2021

Blood Supply to the Foot

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  • 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
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