LOWER LIMB

1. ANTERIOR TIBIAL ARTERY

4. Anterior Tibial Artery
• This is an important artery of the anterior
compartment of the leg.
– It is corresponding to the posterior interosseous artery
of the forearm.
• The blood supply to the anterior compartment of
the leg is suppoerted by the perforating branch
of peroneal artery. Hence, the size of peroneal
artery is inversely proportional to that of the
anterior tibial artery.
• The anterior tibial artery is accompanied by two
venae comitantes.

6. ORIGIN
•Anterior tibial artery is the
smaller terminal branch
of popliteal artery given at
the lower border
of popliteus muscle.

7. COURSE
• It commences on the back of the leg at the lower
border of popliteus.
• It enters the anterior compartment of the leg by
passing forward between both heads of the tibialis
posterior, via an opening in the upper part of the
interosseous membrane.
• In the anterior compartment, it runs vertically
downward to a point midway between the medial
and lateral malleoli, where it enters the foot and
changes its name to dorsalis pedis artery, which
finishes between the big and 2nd toes.

9. Relations
• In the upper 1/3rd of the leg it is located
between the tibialis
anterior and extensor digitorum longus.
• In the middle 1/3rd of the leg it is located
between the tibialis anterior
and extensor hallucis longus.
• In the lower 1/3rd of the leg it is located
between extensor hallucis longus and
extensor digitorum longus.

10. Relations
• It is crossed from the lateral to
medial side by the tendon of
extensor hallucis longus.
• Because of this, the anterior tibial
nerve is located lateral to it in its
upper 1-third and lower 1/3rd and
anterior to it in its middle 1/3rd.

12. BRANCHES
• Anterior and posterior tibial recurrent
arteries: These take part in the arterial
anastomosis around the knee joint.
• Muscular branches to adjacent muscles.
• Anterior medial and anterior lateral
malleolar arteries take part in the
anastomosis around the ankle joint.

13. Variations of the anterior tibial artery
• The anterior tibial artery may neglect to
grow more when compared to a short
way down the leg. In such cases,
the dorsalis pedis artery originates from
the perforating branch of the peroneal
artery or perforating branch of
the posterior tibial artery.

14. POSTERIOR TIBIAL ARTERY

15. ORIGIN
• Posterior Tibial Artery is the bigger
branch of both terminal branches of
the popliteal artery because its
branches not only supply the
posterior compartment but also
the lateral compartment of the
leg and the sole of the foot.

17. Posterior
view of the
leg showing
the tibial
nerve and
the
posterior
tibial artery.
Anterior
view of the
leg showing
the common
fibular
nerve and
the anterior
tibial artery.

18. COURSE
• It starts at the lower border
of popliteus, between
the tibia and fibula, deep
to gastrocnemius and enters the
back of the leg by passing deep to
the tendinous arch of soleus.

19. RELATIONSHIPS
• In the leg, it goes downward and somewhat
medially to reach the posteromedial side of the
ankle, midway between the medial malleolus and
the medial tubercle of calcaneum.
• It ends deep to the flexor retinaculum by splitting
into a large lateral plantar artery and a small
medial.
• Throughout its course, it is escorted by the tibial
nerve, which crosses the artery from the medial to
lateral side.

21. BRANCHES
• Peroneal (fibular) artery: It’s the biggest and most important
branch of the posterior tibial artery. The point of origin is 2.5 cm
distal to the inferior border of popliteus.
• Muscular branches: To the muscles of posterior compartment.
• Nutrient artery to tibia: It’s the largest nutrient artery within the
body. It goes into the nutrient foramen of tibia below the soleal
line.
• Circumflex fibular artery: It encircles the lateral side of the neck of
the fibula.
• Communication branch: It joins together with the quite similar
branch of peroneal artery about 5 cm above the ankle.
• Medial malleolar branch: It enters toward the medial malleolus.
• Calcaneal branch: It pierces the flexor retinaculum and supplies
soft tissues of the heel.
• Terminal branches: All these are medial and lateral plantar
arteries of the sole.

23. CLINICAL SIGNIFICANCE
• Posterior tibial pulse: It can be felt against the
calcaneum about 2 cm below and behind the
medial malleolus, and in front of the medial
border of the tendocalcaneus. Since the
posterior tibial artery is located deep to the
flexor retinaculum, it’s significant to request
the patient to invert his or her foot to relax
the flexor retinaculum. Failure to do so may
result in an erroneous judgment that this
pulse is absent.