Blood supply of the leg and foot WINDSOR UNIVERISITY SCHOOL OF MEDICINE Dr. akoladeOsanoto
ARTERIES IN THE POSTERIOR COMPARTMENT • The posterior tibial artery, the larger and more direct terminal branch of the popliteal artery, provides the blood supply to the posterior compartment of the leg and to the foot • It begins at the distal border of the popliteus • Branches • largest branch, the fibular artery . During its descent, the posterior tibial artery is accompanied by the tibial nerve and veins. • The artery runs posterior to the medial malleolus, from which it is separated by the tendons of the tibialis posterior and flexor digitorumlongus(tarsal tunnel) • Inferior to the medial malleolus, it runs between the tendons of the flexor hallucislongus and flexor digitorumlongus. • Deep to the flexor retinaculum the posterior tibial artery divides into medial and lateral plantar arteries
Posterior Tibial Pulse • The posterior tibial pulse can usually be palpated between the posterior surface of the medial malleolus and the medial border of the calcaneal tendon • Palpation of the posterior tibial pulses is essential for examining patients with occlusive peripheral arterial disease. • intermittent claudication, characterized by leg pain and cramps, develops during walking and disappears after rest. These conditions result from ischemia of the leg muscles caused by narrowing or occlusion of the leg arteries
ARTERIES IN THE ANTERIOR COMPARTMENT • Anterior tibial artery supplies structures in the anterior compartment • Begins at the inferior border of popliteus muscle • Passes anterior through the gap in the superior part of the interroseous membrane to descend between the tendons of tibialis anterior and extensor digitorumlongus muscles • Continues in the foot as the dorsalispedis artery
Dorsal Artery of the Foot • The dorsal artery of the foot (L. arteriadorsalisped is the direct continuation of the anterior tibial artery • The dorsal artery begins midway between the malleoli and runs anteromedially, deep to the inferior extensor retinaculumbetween the extensor hallucislongus and the extensor digitorumlongus tendons on the dorsum of the foot. • it divides into the 1st dorsal metatarsal artery and a deep plantar artery. • The deep plantar artery enters the sole of the foot, where it joins the lateral plantar artery to form the deep plantar arch
Other arteries on the dorsum of the foot • The lateral tarsal artery • The 1st dorsal metatarsal artery • The arcuate artery • perforating branches • dorsal digital arteries
Palpation of the DorsalisPedis Pulse • Is evaluated during a physical examination of the peripheral vascular system. • The pulses are usually easy to palpate because the dorsal arteries of the foot are subcutaneous and pass along a line from the extensor retinaculum to a point just lateral to the Extensor HallucisLongus tendons absent dorsalispedis pulse usually suggests vascular insufficiency resulting from arterial disease. The five P signs of acute arterial occlusion are pain, pallor, paresthesia, paralysis, and pulselessness.
ARTERIES IN THE LATERAL COMPARTMENT • By perforating branches of anterior tibial artery proximally • Distally by perforating bracnches of fibular artery