Updated: 10/6/2016

Blood Supply to the Foot

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https://upload.orthobullets.com/topic/12114/images/peroneal_artery.jpg
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https://upload.orthobullets.com/topic/12114/images/posterior_tibial.jpg
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 adductor 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 archorigin
      • 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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