Arterial supply to the foot

Arterial supply to the foot can be divided into plantar and dorsal components.

Plantar arterial supply

Posterior tibial artery 

• gives off its calcaneal branch 
• then divides into the medial and lateral plantar arteries

Medial plantar artery

• branch of the posterior tibial artery
• smaller caliber vessel
• supplies the medial side of the foot, abductor hallucis muscle and flexor digitorum brevis muscle
• provides the arterial digital supply to the big toe
• gives off cutaneous branches that perforate the plantar aponeurosis between abductor hallucis muscle and flexor digitorum brevis muscle

Lateral plantar artery

• branch of the posterior tibial artery
• larger caliber vessel
• crosses the sole obliquely towards the base of the fifth metatarsal bone
• gives off cutaneous branches that perforate the plantar aponeurosis between flexor digitorum brevis and abductor digiti minimi muscles
• gives off a superficial branch that follows its respective nerve
• continues as a deep trunk to form the plantar arch

Plantar arch

• anastomosis of the lateral plantar artery and dorsalis pedis artery
• only arterial plantar arch in the foot
• lies in the neurovascular plane deep to the plantar aponeurosis, superficial to the long tendons (between the first and second anatomical layers)
• travels across the bases of the fourth, third, and second metatarsals and gives off the plantar metatarsal arteries
• joins the dorsalis pedis artery in the proximal part of the first intermetatarsal space

Plantar metatarsal arteries 

• there are four metatarsal arteries
• branch of the plantar arch
• supply the four clefts and digits
• anastomose with the dorsal metatarsal arteries via perforating arteries

Dorsal arterial supply

Dorsalis pedis artery

• continuation of the anterior tibial artery
• starts between the malleoli, over the lower end of the tibia
• runs lateral to extensor hallucis longus muscle 
• runs to the base of the first intermetatarsal space, where its deep branch joins the plantar arch
• also branches to form the medial tarsal artery, lateral tarsal artery, arcuate artery
• continues as the first dorsal metatarsal artery

First dorsal metatarsal artery

• continuation of the dorsalis pedis artery
• supplies the first cleft and the medial side of the dorsum of the great toe

Medial tarsal arteries

• two or three branches from the dorsalis pedis artery
• ramify on the medial border of the foot and join the medial malleolar arterial network

Lateral tarsal artery

• branch of the dorsalis pedis artery 
• travels laterally supplying underlying tarsal bones
• lies beneath extensor digitorum brevis muscle, which it supplies
• anastomoses with perforating branch of the fibular artery (taking part in anastomosis around ankle joint)

Arcuate artery

• branch of the dorsalis pedis artery
• also travels laterally
• runs beneath the tendons of extensor digitorum brevis muscle, over the bases of the metatarsal bones
• gives off dorsal metatarsal arteries
• anastomoses with the lateral tarsal artery

Dorsal metatarsal arteries

• there are three metatarsal arteries
• branches of the arcuate artery
• travel in the lateral three clefts
• give off proximal and distal perforating branches that communicate with the plantar metatarsal arteries of the plantar arch
• continues into the toes as dorsal digital arteries

Variant anatomy

• absence of the dorsalis pedis artery: dorsal supply from the plantar arteries 
• dorsalis pedis as the continuation of the peroneal artery
• hypoplastic dorsalis pedis
• absence of the arcuate artery 
• arcuate artery arising from the lateral tarsal artery 
• supply of the dorsal metatarsal arteries from the plantar arch alone 
• no communication between the plantar and dorsal arch