Posterior tibial artery

Posterior tibial artery
Posterior tibial artery
	Back of left lower extremity, showing surface markings for bones, vessels, and nerves (posterior tibial artery labeled at bottom right).
Details
Source	Popliteal artery
Branches	Fibular artery, medial plantar artery, lateral plantar artery
Vein	Posterior tibial vein
Identifiers
Latin	arteria tibialis posterior
TA98	A12.2.16.055
TA2	4721
FMA	43895
	Anatomical terminology [edit on Wikidata]

The posterior tibial artery of the lower limb is an artery that carries blood to the posterior compartment of the leg and plantar surface of the foot. It branches from the popliteal artery via the tibial-fibular trunk.

Structure

The posterior tibial artery arises from the popliteal artery in the popliteal fossa.^[1] It is accompanied by a deep vein, the posterior tibial vein, along its course. It passes just posterior to the medial malleolus of the tibia, but anterior to the Achilles tendon.^[1] It passes into the foot deep to the flexor retinaculum of the foot.^[1] It runs through the tarsal tunnel.^[2]

Branches

The posterior tibial artery gives rise to:

medial plantar artery.
lateral plantar artery.
fibular artery,^[1] which is said to rise from the bifurcation of the tibial-fibular trunk and the posterior tibial artery.
calcaneal branch to the medial aspect of the calcaneus.

Function

The posterior tibial artery supplies oxygenated blood to the posterior compartment of the leg and the plantar surface of the foot.^[1]

Clinical significance

Palpation of the posterior tibial artery pulse

The posterior tibial artery pulse can be readily palpated halfway between the posterior border of the medial malleolus and the Achilles tendon.^[1] It is often examined by clinicians when assessing a patient for peripheral vascular disease. It is very rarely absent in young and healthy individuals.^[3] In a study of 547 healthy individuals, only one person did not have a palpable posterior tibial artery.^[3] It is easily palpated over Pimenta's Point.

Nerve block

The posterior tibial artery is used as a landmark for the tibial nerve as both structures enter the foot.^[4] Local anaesthetic is injected either side of the artery distal to the flexor retinaculum of the foot, close to the calcaneus.^[4]

Additional images

Cross-section through middle of leg.
Major arteries of the leg (posterior view).
The plantar arteries. Deep view.

References

^ ^a ^b ^c ^d ^e ^f Jacob, S. (2008-01-01), Jacob, S. (ed.), "Chapter 6 - Lower limb", Human Anatomy, Churchill Livingstone, pp. 135–179, doi:10.1016/b978-0-443-10373-5.50009-9, ISBN 978-0-443-10373-5, retrieved 2021-02-21
^ Minieka, Michael; Nishida, Takashi (2005-01-01), Benzon, Honorio T.; Raja, Srinivasa N.; Molloy, Robert E.; Liu, Spencer S. (eds.), "Chapter 54 - Entrapment Neuropathies", Essentials of Pain Medicine and Regional Anesthesia (Second Edition), Philadelphia: Churchill Livingstone, pp. 426–432, doi:10.1016/b978-0-443-06651-1.50058-7, ISBN 978-0-443-06651-1, retrieved 2021-02-21
^ ^a ^b Robertson GS, Ristic CD, Bullen BR. The incidence of congenitally absent foot pulses. Ann R Coll Surg Engl. 1990 Mar;72(2):99-100. PMID 2185683.
^ ^a ^b Doty, Robert; Sukhani, Radha (2005-01-01), Benzon, Honorio T.; Raja, Srinivasa N.; Molloy, Robert E.; Liu, Spencer S. (eds.), "Chapter 78 - Ankle Block", Essentials of Pain Medicine and Regional Anesthesia (Second Edition), Philadelphia: Churchill Livingstone, pp. 672–676, doi:10.1016/b978-0-443-06651-1.50082-4, ISBN 978-0-443-06651-1, retrieved 2021-02-21