Dorsalis pedis artery
The dorsalis pedis artery (a. dorsalis pedis) is the direct distal continuation of the anterior tibial artery below the ankle joint. It is the main source of blood supply to the dorsal surface and also an important contributor to the circulation of the sole, where it gives off its deep plantar branch.
The clinical significance of the artery is immense. First, its pulsation serves as a basic test for assessing peripheral blood flow. Second, the artery is located superficially, making it convenient for flap harvesting and creating distal vascular anastomoses in surgery. One must keep anatomical caution in mind: if the dorsal pulse is not palpable, it does not always indicate disease. In 10–12% of people, the trunk is congenitally weak, and its function is assumed by the perforating branch of the fibular artery.
Plantar arteries and deep arch
After passing beneath the flexor retinaculum in the calcaneal canal, the posterior tibial artery divides into its terminal branches:
- Medial plantar artery (a. plantaris medialis) is a relatively slender branch. It runs in the medial groove of the sole, located between the abductor hallucis muscle and the flexor digitorum brevis muscle.
- Lateral plantar artery (a. plantaris lateralis) is a larger trunk. It lies in the lateral groove (between the flexor digitorum brevis and abductor digiti minimi muscles).
Turning medially, the lateral artery joins with the deep plantar branch (from the dorsalis pedis artery) to form the deep plantar arch (arcus plantaris profundus). It is located at the level of the bases of the metatarsal bones, resting on the interosseous muscles directly beneath the oblique head of m. adductor hallucis. The arch gives off four metatarsal arteries, which further divide into digital arteries.
Practical significance: there are few collaterals at the level of the arch. If it undergoes thrombosis (e.g., in diabetes), ischemia affects all toes of the foot simultaneously.
Networks and anastomoses of the ankle and heel
The ankle joint is the area where all three vascular trunks of the leg converge. Dense networks are formed here, providing collateral blood flow:
- Medial malleolar network (rete malleolare mediale). Formed by branches of the anterior and posterior tibial arteries, as well as the medial plantar artery.
- Lateral malleolar network (rete malleolare laterale). Formed with the participation of the anterior tibial and fibular arteries.
- Calcaneal network (rete calcaneum). Enlaces the tuberosity of the calcaneus and the Achilles tendon region through calcaneal branches of the posterior tibial and fibular arteries.
The fibular artery (a. fibularis) plays the role of the main reserve trunk here. Its perforating branch is capable of replacing the dorsal artery, and the communicating branch functions as a direct shunt to the posterior tibial artery, supporting the sole.
Collateral rule
Although the lower limb is supplied from a single main trunk, there is an alternative pathway at every level (geniculate network, malleolar networks, and connections between the dorsum and sole). However, the survival of the foot depends not only on the level of vascular occlusion, but also on the rate of occlusion.
- In slow occlusion (atherosclerosis), the networks have time to open up. The foot is preserved, and the patient complains only of intermittent claudication.
- In acute occlusion (embolism), the exact same anatomical anastomoses do not have time to dilate, and acute critical ischemia develops immediately.
Briefly: answers to topical questions
What branches does the dorsalis pedis artery give off along its course?
Along its course, the dorsalis pedis artery gives off tarsal, arcuate, and terminal branches.
- Medial tarsal arteries (aa. tarsales mediales) are slender branches running toward the medial margin of the foot.
- Lateral tarsal artery (a. tarsalis lateralis) is a large branch passing laterally beneath the extensor digitorum brevis muscle.
- Arcuate artery (a. arcuata) arises at the level of the bases of the metatarsal bones and courses laterally.
- First dorsal metatarsal artery (a. metatarsalis dorsalis prima) is a terminal branch running into the first intermetatarsal space.
- Deep plantar branch (r. plantaris profundus) is a terminal branch piercing the first intermetatarsal space to anastomose with the plantar arch.
What branches arise from the deep plantar arch?
The plantar metatarsal arteries arise from the deep plantar arch.
- Plantar metatarsal arteries (aa. metatarsales plantares I–IV) are four arteries lying in the interosseous spaces.
At the level of the heads of the metatarsal bones, each of these arteries divides into two common plantar digital arteries (aa. digitales plantares communes), which then divide into proper plantar digital arteries (aa. digitales plantares propriae). Branches to the tarsal bones also originate from the arch, participating in the formation of the plantar part of the tarsal network.
Which specific arterial branches form the medial malleolar network?
The medial malleolar network is formed by branches of the anterior and posterior tibial arteries, as well as the dorsalis pedis artery.
- Medial anterior malleolar artery (a. malleolaris anterior medialis) arises from the anterior tibial artery.
- Medial malleolar branches (rr. malleolares mediales) arise from the posterior tibial artery.
- Medial tarsal arteries (aa. tarsales mediales) are branches of the dorsalis pedis artery.
- Branches of the medial plantar artery (a. plantaris medialis) ascend to the network from below on the plantar side.
Which branches participate in the formation of the lateral malleolar network?
Branches of the anterior tibial, fibular, and dorsalis pedis arteries participate in the formation of the lateral malleolar network.
- Lateral anterior malleolar artery (a. malleolaris anterior lateralis) is a branch of the anterior tibial artery.
- Lateral malleolar branches (rr. malleolares laterales) arise from the fibular artery.
- Perforating branch (r. perforans) arises from the fibular artery and pierces the interosseous membrane.
- Lateral tarsal artery (a. tarsalis lateralis) is a branch of the dorsalis pedis artery.
The dorsal and plantar surfaces of the foot are connected on two "levels": the first is the robust deep plantar branch, and the second comprises the perforating branches from the plantar arch.
Class and exam questions
What forms the deep plantar arch?
It is formed by the union of the large lateral plantar artery with the deep plantar branch coming from the dorsalis pedis artery.
Why can all toes be affected simultaneously in diabetic foot syndrome?
In thrombosis of the deep plantar arch, bypass pathways (collaterals) at the level of the metatarsal bones are very sparse, which is why ischemia affects all toes simultaneously.
What is the danger of calcaneal region injuries?
The calcaneal network (rete calcaneum) has a relatively poor blood supply. Consequently, any wounds or ruptures of the Achilles tendon in this area heal slowly.
Is the absence of a pulse on the dorsum of the foot always pathological?
No. In 10–12% of people, the dorsalis pedis artery is poorly developed, and its function is performed by the perforating branch of the fibular artery, so the absence of a pulse can be a normal variant.
What else to study on this topic
- Course and projection lines of the dorsalis pedis artery
- Tarsal, arcuate, and metatarsal branches of the dorsum of the foot
- Genicular articular network (rete articulare genus)
- Summary diagrams of tarsal anastomoses
- Cruciate anastomosis of the hip joint
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