Medial and Lateral Plantar Arteries and Deep Veins Flashcards
General information about medial plantar artery
o Terminal branch of the posterior tibial artery
o SMALLER of the two branches
o Travels medially across the foot along with the medial plantar nerve
o Originates deep to flexor retinaculum between the medial malleolus and calcaneus
Course of medial plantar artery
o Enters medial compartment of plantar surface
o Runs deep to abductor hallucis (1st layer) and superficial to flexor digitorum longus (2nd layer) then gives off small muscular branch to abductor hallucis (1st layer)
o After crossing flexor digitorum longus tendon, divides into superficial and deep branch
Superficial branch of medial plantar artery
Runs between two muscles of first layer
- Abductor hallucis
- Flexor digitorum brevis
Gives off two terminal branches
- Superficial tibial plantar artery
- Common plantar digital artery
Superficial tibial plantar artery
o Courses most medially
o Runs superficial to flexor hallucis brevis muscle and lateral to abductor hallucis tendon
o Usually very small
o Becomes 1st proper plantar digital artery
o Anastomosis: The distal end of the superficial tibial plantar artery (before becoming 1st proper plantar) can anastomose with the 1st plantar metatarsal artery of the deep plantar arch
o Variation: If the superficial tibial plantar artery is large, it is usually because it REPLACES the 1st plantar metatarsal artery
Common plantar digital artery
o Will eventually become the superficial plantar digital arch
o Artery passes obliquely across flexor hallucis brevis muscle and is located between plantar aponeurosis and flexor digitorum brevis - VERY SUPERFICIAL
Superficial plantar digital arch
o Three small branches: 1st superficial plantar digital artery, 2nd superficial plantar digital artery, 3rd superficial plantar digital artery
o These superficial plantar digital arteries flow into plantar metatarsal arteries of the deep plantar arch
o 30% of the time, the common plantar digital artery proceeds beyond superficial plantar digital arch to anastomose with superficial branch of lateral plantar artery (complete anastomosis)
Deep branch of medial plantar artery
RAMUS PROFUNDUS
o Travels deeper than superficial branch of medial plantar artery
o Divides into two terminal branches: Tibial branch of ramus profundus and lateral branch of ramus profundus
Tibial branch of ramus profundus
o Travels medially and superficially
o Superficial branch that anastomoses with 1st plantar metatarsal artery from deep plantar arch
Lateral branch of ramus profundus
o Travels deeper than tibial branch
o Located between 3rd and 4th muscle layers where it crosses over peroneus longus tendon and joins medial side of deep plantar arch
o Completes the arch medially (right by deep plantar branch of dorsalis pedis)
General information about the lateral plantar artery
o LARGER than medial plantar artery
o Nerve lies medial to lateral plantar artery
o Enters the foot deep to the abductor hallucis muscle (porta pedis)
Course of lateral plantar artery
o Travels laterally to run in middle compartment between flexor digitorum brevis (1st layer) and quadratus plantae (2nd layer)
o Continues toward base of 5th metatarsal and penetrates intermuscular septum to enter lateral compartment
o Then proceeds distally along medial side of abductor digiti minimi muscle
Branches of lateral plantar artery
o Once the artery is close to the base of the 5th metatarsal, it divides into a superficial fibular plantar artery (more lateral) and deep plantar arch (more medial)
Superficial fibular plantar artery
o Goes straight to lateral aspect of 5th metatarsal to become 10th proper plantar digital artery
Deep plantar arch
o Can just appear as a continuation of lateral plantar artery (quite large)
Course of deep plantar arch
Proceeds medially between 3rd and 4th layer of muscle (used as landmark to separate)
- Deep to flexor digiti minimi brevis (3rd)
- Deep to oblique head of adductor hallucis (3rd)
- Superficial to interossei muscles
Anastomosis of deep plantar arch
On medial side of 1st intermetatarsal space, deep plantar arch anastomoses with
• Deep plantar branch of dorsalis pedis (from dorsum)
• Lateral branch of ramus profundus (from medial plantar artery)
NOTE: if dorsalis pedis is missing, there is usually NO contribution from dorsum
• Perforating branch of peroneal artery could also contribute to arch
Branches of deep plantar arch
NOTE: there are many deep muscular branches to the plantar muscles of the foot and many perforating arteries to the dorsum of the foot
These include
- 3 posterior (proximal perforating arteries)
- 4 plantar metatarsal arteries
- Distal (anterior) perforating arteries
- Proper plantar arteries
- 1st proper plantar digital artery
- 10th proper plantar digital artery
3 posterior (proximal) perforating arteries
- Arise from the arch itself
- None for the 1st interspace due to the deep plantar branch from the dorsalis pedis
- Sends blood to the dorsal metatarsal arteries
4 plantar metatarsal arteries
- Arise from the arch itself
- Course along the plantar side of the medial 4 metatarsals, superficial to the interossei
Variations in plantar metatarsal arteries
- 1st plantar metatarsal can be a branch of the dorsalis pedis
- 1st plantar metatarsal can branch from the superficial tibial plantar branch of the medial plantar artery
- 2-3% have missing plantar metatarsals and the superficial plantar arterial system compensates for digital blood flow
Distal (anterior) perforating arteries
- Close to webbing of all 4 plantar metatarsal arteries
- Penetrates through the interossei to reach dorsal metatarsal arteries
Proper plantar arteries
Travel distally to supply the toes - there are 8 in number (2nd - 9th)
1st proper plantar digital artery
- Direct branch from the 1st plantar metatarsal artery (usually)
- Courses across the 1st metatarsal and anastomoses with superficial tibial plantar artery (from medial plantar artery)
- This forms a trunk called the 1st proper plantar digital artery
- Sometimes the 1st plantar metatarsal does NOT contribute to this artery and it is a direct continuation of the superficial plantar tibial artery
10th proper plantar digital artery
Direct continuation of superficial fibular plantar artery
Blood supply to toes
- Dorsal digital arteries to digits 2-5 are often not well developed, so the main source of blood to the toes is the proper plantar digital arteries, especially for the lateral 2 toes
Anastomosis on the toes
- Proper plantar digital arteries from the medial and lateral sides anastomose with each other
- There is a network of anastomosis on the distal phalanx called the terminal arborization
Deep veins of the foot
We are moving on, FYI
Proper plantar digital veins
- Communicate with the dorsal digital veins
- They then unite to form 4 plantar metatarsal veins
- The plantar metatarsal veins (in the metatarsal spaces) send perforating branches to the dorsum of the foot
- They then unite to form the deep plantar venous arch
Deep plantar venous arch
- Follows the deep plantar arterial arch across the interossei muscles
- The medial and alteral plantar veins originate from the arch
- They run along with the arteries to the same place
Communicating veins
- Between the medial and lateral plantar veins (usually)
- Between the small and great saphenous veins (usually)
Posterior tibial veins
Formed by the union of medial/lateral plantar veins (inferior to the medial malleolus)
Anterior tibial veins
Originate from the venous plexus along the dorsum of the foot
