Medial and Lateral Plantar Arteries and Deep Veins Flashcards Preview

Lower Limb > Medial and Lateral Plantar Arteries and Deep Veins > Flashcards

Flashcards in Medial and Lateral Plantar Arteries and Deep Veins Deck (32):
1

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

2

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

3

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

4

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

5

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

6

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)

7

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

8

Tibial branch of ramus profundus

o Travels medially and superficially
o Superficial branch that anastomoses with 1st plantar metatarsal artery from deep plantar arch

9

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)

10

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)

11

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

12

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)

13

Superficial fibular plantar artery

o Goes straight to lateral aspect of 5th metatarsal to become 10th proper plantar digital artery

14

Deep plantar arch

o Can just appear as a continuation of lateral plantar artery (quite large)

15

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

16

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

17

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

18

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

19

4 plantar metatarsal arteries

- Arise from the arch itself
- Course along the plantar side of the medial 4 metatarsals, superficial to the interossei

20

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

21

Distal (anterior) perforating arteries

- Close to webbing of all 4 plantar metatarsal arteries
- Penetrates through the interossei to reach dorsal metatarsal arteries

22

Proper plantar arteries

Travel distally to supply the toes - there are 8 in number (2nd - 9th)

23

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

24

10th proper plantar digital artery

Direct continuation of superficial fibular plantar artery

25

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

26

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

27

Deep veins of the foot

We are moving on, FYI

28

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

29

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

30

Communicating veins

- Between the medial and lateral plantar veins (usually)
- Between the small and great saphenous veins (usually)

31

Posterior tibial veins

Formed by the union of medial/lateral plantar veins (inferior to the medial malleolus)

32

Anterior tibial veins

Originate from the venous plexus along the dorsum of the foot