Anterior tibial artery and dorsum of the foot
Originating from the popliteal artery at the level of the lower border of the m. popliteus, the anterior tibial artery pierces the interosseous membrane and enters the anterior fascial compartment of the leg. It descends along the anterior surface of the membrane, supplying the muscles of the anterior compartment (there are virtually no collaterals within the compartment). In the lower third, it is crossed anteriorly by the tendon of the extensor hallucis longus, so near the ankle joint, the vessel lies lateral to this tendon. The artery is accompanied by the deep peroneal nerve (n. fibularis profundus).
After passing under the extensor retinaculum, the main trunk becomes the dorsalis pedis artery (a. dorsalis pedis). It lies directly on the tarsal bones (talus, navicular, and cuneiforms), making its pulse easy to palpate. It gives off the tarsal arteries, the arcuate artery (a. arcuata), and its most important terminal branch—the deep plantar branch (r. plantaris profundus), which pierces the first intermetatarsal space and passes to the sole.
Plantar arteries
The posterior tibial artery in the foot divides into two terminal branches running in their respective sulci together with the corresponding nerves (nerves always lie lateral to the arteries).
- Medial plantar artery (a. plantaris medialis) is the smaller branch. It runs in the medial sulcus beneath the plantar aponeurosis. It supplies the muscles of the thenar eminence of the foot and the skin of the medial margin of the foot. It does not participate in the formation of the plantar arch.
- Lateral plantar artery (a. plantaris lateralis) is the main vessel of the sole. It runs in the lateral sulcus and at the base of the fifth metatarsal bone turns sharply medially into the deep layer of the sole. Here it anastomoses with the deep branch of the dorsalis pedis artery, forming the plantar arch (arcus plantaris profundus).
Four plantar metatarsal arteries arise from the plantar arch and then divide into common and proper plantar digital arteries. Injuries in the projection of the lateral sulcus cause severe bleeding: the vessel is trapped between bones and the aponeurosis and does not collapse.
Arterial networks and anastomoses
The vessels of the leg and foot form several critically important networks:
- Genicular articular network (rete articulare genus) is the only collateral pathway bypassing the popliteal artery. It includes branches from the femoral, popliteal, and tibial arteries.
- Malleolar networks (retia malleolaria) — medial and lateral. They serve as a switching point for blood flow between the anterior and posterior compartments of the leg in case of occlusion of one of the main vessels.
- Tarsal network (rete tarsi) is located on the bones of the foot, connecting the malleolar networks with the metatarsal vessels.
The dorsum and sole of the foot are reliably connected at three levels: by the deep plantar branch, as well as the proximal and distal perforating branches (rr. perforantes). Thanks to this system, the foot survives if at least one tibial artery is patent.
Briefly: answers to topical questions
What branches does the anterior tibial artery give off in the leg?
In the leg, the anterior tibial artery gives off recurrent, muscular, and malleolar branches.
- Posterior tibial recurrent artery (a. recurrens tibialis posterior) is an inconstant branch that ascends to the capsule of the knee joint.
- Anterior tibial recurrent artery (a. recurrens tibialis anterior) ascends to the knee joint and participates in the genicular articular network.
- Muscular branches (rr. musculares) are numerous short branches to all muscles of the anterior compartment.
- Anterior medial malleolar artery (a. malleolaris anterior medialis) runs medially and participates in the medial malleolar network.
- Anterior lateral malleolar artery (a. malleolaris anterior lateralis) runs laterally and participates in the lateral malleolar network.
Which specific arteries form the genicular articular network?
The genicular articular network (rete articulare genus) is formed by branches of the femoral, popliteal, and tibial arteries.
- Descending genicular artery (a. descendens genus) and the descending branch (r. descendens a. circumflexae femoris lateralis) from the femoral artery system.
- Superior and inferior genicular arteries (a. superior lateralis genus, a. superior medialis genus, a. inferior lateralis genus, a. inferior medialis genus) from the popliteal artery. The middle genicular artery does not enter the network.
- Anterior and posterior tibial recurrent arteries (aa. recurrentes tibiales anterior et posterior) — from the anterior tibial artery.
- Fibular circumflex branch (r. circumflexus fibularis) — from the posterior tibial artery.
What branches does the posterior tibial artery give off in the leg?
In the leg, the posterior tibial artery gives off branches to the knee joint, ankle, heel, and the large main trunk.
- Fibular circumflex branch (r. circumflexus fibularis) heads toward the genicular network.
- Fibular artery (a. fibularis or a. peronea) is the largest branch arising in the upper third of the leg.
- Medial malleolar branches (rr. malleolares mediales) participate in the formation of the medial malleolar network.
- Calcaneal branches (rr. calcanei) head toward the calcaneal region and participate in the calcaneal network.
Which arteries participate in the formation of the malleolar networks?
In the ankle region, two malleolar networks are formed, involving branches of all three leg arteries and the foot arteries.
| Network | Sources of blood supply |
|---|---|
| Medial malleolar network (rete malleolare mediale) | Anterior medial malleolar artery (a. malleolaris anterior medialis), medial malleolar branches (rr. malleolares mediales), medial tarsal arteries (aa. tarsales mediales), branches of the medial plantar artery (a. plantaris medialis). |
| Lateral malleolar network (rete malleolare laterale) | Anterior lateral malleolar artery (a. malleolaris anterior lateralis), lateral malleolar branches (rr. malleolares laterales), perforating branch (r. perforans), lateral tarsal artery (a. tarsalis lateralis). |
To avoid confusing the plantar branches, remember: "Medial is Minor (M - M) and supplies only the margin, while Lateral is Leader (L - L), it is larger and forms the main arch."
Class and exam questions
Which artery penetrates inside the knee joint?
Only the middle genicular artery (a. media genus) penetrates inside the joint. It supplies the cruciate ligaments, and its damage causes hemarthrosis.
Does the medial plantar artery participate in the formation of the plantar arch?
No, it does not participate. The plantar arch is formed by the lateral plantar artery and the deep plantar branch of the dorsalis pedis artery.
Why might the ankle pulse be preserved in diabetes despite toe necrosis?
In diabetic angiopathy, small distal branches (metatarsal and digital) are affected first. The major arteries remain patent, so the pulse is palpable despite tissue ischemia.
What else to study on this topic
- Formation and topography of the genicular articular network (rete articulare genus)
- Topography of neurovascular bundles in the layers of the sole
- Projection lines of the anterior tibial and dorsalis pedis arteries
- Features of the blood supply to the menisci of the knee joint
- Surgical approaches to the dorsum of the foot and preservation of the arcuate artery
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