Arteries of the Lower Leg

29 Arteries of the Lower Leg

T. Rodt, M. Lee

The peroneal artery is the most consistently encountered artery in the lower leg. Parts of this artery stem from the original artery of the lower limb (Chapter 26). The variations in the arteries of the lower leg can be best explained by treating the peroneal artery as the main artery and defining the tibial arteries as its branches. If one of the tibial arteries is lacking or very small, the peroneal artery supplies that part of the foot. If the anterior tibial artery is absent, the perforans branch of the peroneal artery forms the dorsal artery of the foot, or if the posterior tibial artery is absent, the peroneal artery forms the plantar arteries. The peroneal artery is therefore a major contributor to the blood supply of the foot in approximately 12% of all cases. Normally, however, the peroneal artery ends in the malleolar and the calcanean areas.¹^–⁴

An interesting variability has been described for the nutrient artery of the tibia. In about 50% of all cases this artery branches from the posterior peroneotibial trunk, but it can also branch from the popliteal artery (at the bifurcation), the posterior or anterior tibial artery, or—rarely—the peroneal artery.⁵ Depending on the origin of the nutrient artery, the nutrient foramen is most commonly found on the posteromedial surface in the upper third of the diaphysis. The location of the nutrient foramen is important in stress fractures, orthopaedic surgical procedures, and medicolegal cases.⁶

Fig. 29.1 The normal situation as shown in textbooks: the peroneal artery has a communicating branch to the posterior tibial artery and a perforating branch to the anterior tibial artery (88%). Schematic (a), anteromedial 3D-VR CT (b), and lateral MIP CTA with bones removed (c). 1 Peroneal artery; 2 posterior tibial artery;
3 communicating peroneal branch;
4 perforating peroneal branch;
5 anterior tibial artery.