The arteries of the lower limbs serve as blood conduits to the tissues of the lower limbs. They are larger relative to the arteries of the upper limbs.

In this video, we will consider the anatomy of the posterior tibial artery and its branches, as well as its areas of blood supply.

Posterior tibial artery

The posterior tibial artery (a. tibialis posterior) is a direct continuation of the popliteal artery. It arises at the level of the inferior border of the popliteal fossa. It passes in the cruropopliteal canal between the soleus muscle (posteriorly) and the posterior tibial muscle and the common flexor digitorum (anteriorly). It exits the canal under the medial border of the soleus muscle, then goes medially. In the ankle joint area, it passes to the sole behind the medial malleolus under the flexor retinaculum, in a separate fibrous canal, and is covered with skin and fascia. Descending to the sole, the posterior tibial artery divides into terminal branches.

BRANCHES

Along its course it gives off eight branches, not counting the terminal ones:

1. The circumflex fibular branch (r. circumflexus fibularis)

   

2. The fibular artery (a. fibularis)

   

3. The nutrient artery (a. nutricia)

4. Muscular branches (rr. musculares)

5. Perforating branches (rr. perforantes)

6. The communicating branch (r. communicans)

   

7. The medial malleolar branches (rr. maleolares mediales)

   

8. The calcaneal branches (rr. calcanei)

The terminal branches include:

1. The medial plantar artery (a. plantaris medialis)

   

   

2. The lateral plantar artery (a. plantaris lateralis)

BRANCHES ARISING ALONG THE COURSE

The circumflex fibular branch (r. circumflexus fibularis) goes to the head of the fibula.

It supplies the nearby muscles with blood.

This branch anastomoses with the genicular arteries.

The fibular artery (a. fibularis) runs laterally under the flexor hallucis longus muscle, adjacent to the fibula. Then it goes down and passes in the inferior musculofibular canal along the posterior surface of the interosseous membrane of the leg, giving branches to the triceps surae muscle of the leg, as well as fibularis longus and brevis muscles. Behind the lateral malleolus of the fibula, the fibular artery divides into terminal branches:

• The lateral malleolus branches (rr. maleolares laterales)

  

• The calcaneal branches (rr. calcanei), which participate in the formation of the calcaneal anastomosis (rete calcaneum).

  

  

• The perforating branch (r. perforans), which passes down and anastomoses with the anterior lateral malleolar artery (from the anterior tibial artery).

  

• The communicating branch (r. communicans) communicates the fibular artery with the posterior tibial artery in the lower third of the leg.

The nutrient artery (a. nutricia) arises distal to the circumflex fibular artery. It enters the tibia below the plantar line.

It supplies the tibia with blood.

Musclar branches (rr. musculares) supply the adjacent muscles of the leg with blood.

Perforating branches (rr. perforantes) pass between the soleus muscle and the flexor digitorum longus. There are usually five of them, each of which is divided into anterior and posterior parts.

They supply the skin and fascia of the posterior surface of the leg with blood.

The communicating branch (r. communicans) runs deep into the flexor hallucis longus above the distal end of the tibia.

It anastomoses with the communicating branch of the fibular artery.

Medial malleolar branches (rr. malleolares mediales) surround the medial malleolus and form the medial malleolar network (rete maleolare mediale).

They supply the skin of the medial malleolus area with blood.

The calcaneal branches (rr. calcanei) arise proximal to the terminal bifurcation of the posterior tibial artery. They pierce the flexor retinaculum.

These branches supply the skin above the caleaneal tendon and calcaneus, as well as the muscles of the medial part of the sole of the foot with blood.

They anastomose with medial malleolus arteries and calcaneal branches of the peroneal artery.

TERMINAL BRANCHES

In the plantar region of the foot, the posterior tibial artery divides into medial and lateral plantar arteries that supply the muscles of the sole of the foot with blood. These branches are terminal.

The medial plantar artery (a. plantaris medialis) – passes between the abductor hallucis muscle and the flexor digitorum brevis. Having reached the medial border of the great toe, it anastomoses with the branch of the firs lantar metatarsal artery. Together with the medial plantar nerve and vein, it forms the medial neurovascular bundle of the foot

At the base of the first metatarsal, it is divided into three superficial digital branches, which are anastomosed with the first, second, and third plantar metatarsal arteries.

The lateral plantar artery (a. plantaris lateralis) passes obliquely and laterally over the quadratus plantae muscle, passing deep to the abductor hallucis muscles, the short flexor of the fingers and the abductor digiti minimi muscle. Then it circumflexes the lateral edge of the oblique head of the adductor hallucis muscle, passes deep to it, and goes medially. Together with the lateral plantar nerve and vein, it forms the lateral neurovascular bundle of the foot.

Dictionary

The posterior tibial arteryand its branches

Posterior tibial artery

a. tibialis posterior

Circumflex fibular branch

r. circumflexus fibularis

Fibular artery

a. fibularis

Lateral malleolar andcalcaneal branches

rr. malleolares laterales et rr. calcanei

Calcaneal network

rete calcaneum

Perforating branch

r. perforans

Communicating branch

a. communicans

Nutrient artery

a. nutricia

Muscular branches

rr. musculares

Perforating branches

rr. perforantes

Communicating branch

r. communicans

Medial malleolar branches

rr. malleolares mediales

Medial malleolar network

rete malleolare mediale

Calcaneal branches

rr. calcanei

Medial plantar artery

a. plantaris medialis

Lateral plantar artery

a. plantaris lateralis