Download Posterior tibial artery

Posterior tibial artery
It is the direct continuation of the popliteal artery,
supply the muscles of the back and it is the main artery
of the foot begin at the lower border of the popliteus m.
then descend with the tibial nerve and two venae
commitants deep to the gastrocnemius, soleus and the
transverse intermuscular septum of the leg. it runs first
laterally and after it gives the peroneal artery it inclines
medially then passes behind the medial malleolus. It
ends by dividing into medial and lateral planter arteries
deep to flexor retinaculum.
• Branches in the leg:
• 1-peroneal artery it is the largest branch. it gives:
• a-muscular branches to the muscles of the lateral
compartment of the leg.
• b-Nutrient branch to the fibula.
• c-Perforating artery.
• d- lateral calcaneal and posterior lateral malleolar.
Posterior tibial artery
• 2- circumflex fibular artery runs around the neck of
the fibula supply skin and muscles.
• 3-Nutrient artery to the tibia.
• 4-Muscular branches to the deep muscles of the back
of the leg.
• 5-Communicating branch with the peroneal artery
behind the ankle joint.
• 6-Medial calcanean artery.
• 7-Posterior medial malleolar to the posterior part of the
medial malleolus.
Posterior tibial artery
Synovial sheaths of the extensor tendons
There are 3 separate synovial sheaths:
• 1- Surrounding the tendon of the tibialis anterior m.
• 2- Surrounding the extensor hallucis longus m.
• 3- Surrounding the tendon of the extensor digitorum
longus and peroneus tertius.
Synovial sheaths
Extensor expansions
• It is similar to that of the fingers formed from the tendons
of the extensor digitorum longus muscle, each tendon
divided into 3 parts at the metatarsophalangeal joint. The
thick central part inserted in the base of the middle
phalanx. The lateral and medial parts of the expansion
continue distally inserted in the base of the distal
phalanx. The tendons of the lumbrical muscles join the
medial side of the expansion in each toe.
Synovial sheath of the flexor tendons
Each tendon deep to the flexor retinaculum is separated
from
others
by
tendenous
sheath
and
each
is
surrounded by its own synovial sheath, this sheath begin
approximately 2cm above the tip of the medial malleolus,
that of the flexor digitorum longus extend to the middle of
the foot, that of the tibialis posterior m. extend to its
insertion while that of the flexor hallucis longus m.
extends either to the middle of the foot or to the insertion.
Sole of the foot
• The skin of the sole is thickened over the
heel and the heads of the metatarsal
bones while it is thin on the toes.
• Superficial fascia it is dense especially
over the heel and the ball of the foot and
contain fats.
Cutaneous nerves of the sole
• 1- medial calcaneal branches from the tibial
nerve distributed to the heel and the posterior
part of the of the sole.
• 2- lateral calceneal branches from the sural
nerve.
• 3- planter cutaneous branches from the lateral
and medial planter nerves.
• 4- Planter digital nerves.
Deep fascia (planter fascia)
• it is continuous with the fascia of the dorsum of the foot,
it is extremely thick in the intermediate region forming
the planter aponeurosis but it is thin medially and
laterally where it covers the abductors of the big and little
toe.
• The thinner medial planter fascia covers the intrinsic
muscles of the great toe. The lateral planter fascia is
thick near the heel and thin toward the little toe covers
the intrinsic muscles of the little toe.
Planter aponeurosis
• it consists of longitudinally arranged bands of
white fibrous connective tissues which diverge
toward the toes from the medial process of the
tuberosity of the calcaneus. it is triangular in
shape occupy the central part of the sole.
Anteriorly it widens and split into 5 slips near the
heads of the metatarsal bones, each slip pass to
one toe bound to the proximal phalanx.
compartments of the sole
The sole divided into 3 compartments:
•
A great toe compartment located medially under the
medial planter fascia.
•
A little toe compartment located laterally under the
lateral planter fascia.
•
The central compartment located deep to the planter
aponeurosis
bounded
by
the
lateral
and
medial
intermuscular septa.
• The interosseous adductor compartment lies deep to the
central compartment
The great toe compartment
• This compartment contains the abductor
hallucis and flexor hallucis brevis muscles,
the medial planter nerve and vessels, and
the first metatarsal bone.
The medial planter nerve
• It is the larger of the two terminal branches of the tibial
nerve. It arise deep to the posterior part of the abductor
hallucis and passes forward accompanied by the small
medial planter artery It gives:
• 1-muscular branches to the abductor hallucis and flexor
digitorum brevis muscles.
• 2- articular branches supply the joint and tarsal and
metatarsal bones.
• 3- planter cutaneous branches supply the skin of the
medial part of the sole.
• The medial planter nerve become cutaneous at
the middle of the sole divided into proper digital
branch to the medial side of the great toe which
supply the flexor hallucis brevis muscle.
• Three common digital branches supply the
medial three and half toes. The first common
digital branch supply the first lumbrical muscle.
Planter nerves
The medial planter artery
• The smaller branch of the posterior tibial
artery, it does not form an arch it
accompanied the medial planter nerve and
lies first under the abductor hallucis and
then between it and the flexor digitorum
brevis muscle, supplying these muscles.
• It gives small branches to the skin, the
muscles and the joints, the artery divided
into
three
anastomosed
digital
with
branches
the
three
which
planter
metatarsal arteries of the planter arch at
the base of the first three interdigital cleft