BLOOD SUPPLY OF THE LEG AND FOOTWINDSOR UNIVERISITY SCHOOL OF MEDICINE

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 digitorum longus(tarsal tunnel)

Inferior to the medial malleolus, it runs between the tendons of the flexor hallucis longus and flexor digitorum longus.

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 digitorum longus muscles

Continues in the foot as the dorsalis pedis artery

DORSAL ARTERY OF THE FOOT The dorsal artery of the foot (L. arteria dorsalis ped

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 retinaculum between the extensor hallucis longus and the extensor digitorum longus 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 DORSALIS PEDIS 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 Hallucis Longus tendons

absent dorsalis pedis 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

VENOUS DRAINAGE OF THE LOWER LIMB.Significance of venous return from the lower

limb-antigravity.The are subdivided superficial and deep

veins the superficial veins are between the two layers of superficial fascia while the deep veins accompany the arteries.

Both sets of veins are provided with valves more numerous in the deep than in the superficial set.

The great saphenous vein (long saphenous vein) is the longest vein in the body. Begins in the medial marginal vein of the dorsum of the foot and ends in the femoral vein about 3 cm below the inguinal ligament. It passes in front of the medial malleolus and along the medial side of the leg in relation with the saphenous nerve behind the medial condyles of the tibia and femur and along the medial side of the thigh to end in the femoral vein. 

Main Tributaries:-superficial circumflex iliac

-superficial external pudendal

-Small saphenous vein

( short saphenous vein)begins behind the lateral malleolus as a continuation of the lateral marginal vein,ascends and then crosses it to reach the middle of the back of the leg. It perforates the deep fascia at the popliteal fossa and ends in the popliteal vein

Tributaries-Branch from great saphenous vein-Lateral marginal vein- Numerous tributaries from the back of the leg.

The great and small saphenous veins and their tributaries

Deep veinsThey accompany the arteries and their branches; they possess numerous valves.

The deep plantar venous arch lies alongside the plantar arterial arch drains into the medial and lateral plantar veins

The posterior tibial vein accompanies the posterior tibial artery and joined by the peroneal vein.

The anterior tibial vein is the upward continuation of the venæ comitantes of the dorsalis pedis artery. They leave the front of the leg by passing between the tibia and fibula, over the interosseous membrane, and unite with the posterior tibial vein to form the popliteal vein. 

The Popliteal Vein ascends through the popliteal fossa to the opening in the Adductor magnus, where it becomes the femoral vein. It receives tributaries corresponding to the branches of the popliteal artery, and the small saphenous vein.

The femoral vein accompanies the femoral artery through the upper two-thirds of the thigh. It receives many muscular tributaries, and about 4 cm below the inguinal ligament is joined by the deep femoral vein and is joined by the great saphenous vein before it terminates. The deep femoral vein receives tributaries corresponding to the perforating branches of the profunda artery, and through these establishes communications with the popliteal vein below and the inferior gluteal vein above. It also receives the medial and lateral femoral circumflex veins.   

POPLITEAL VEIN Formed by union of

venae comitantes of ant, post tibial arteries.

At the lower border of popliteus.

Continues as femoral vein at adductor opening.

TRIBUTARIES: 1- Veins accompany

arteries. 2- Small saphenous v.

Clinical applicationclinical study- angiography palpation for pulses gangrenevaricose veins