Overview

The artery descends on tibialis posterior and then on the back of the tibia, deep to soleus, accompanied by the tibial nerve and two veins. Near its origin it gives off the fibular artery and the nutrient artery of the tibia, the largest nutrient artery in the body.

At the ankle it enters the tarsal tunnel under the flexor retinaculum. Here the structures lie, from front to back, as tibialis posterior, flexor digitorum longus, the artery, its veins, the tibial nerve and flexor hallucis longus. Its pulse is felt behind the medial malleolus, about halfway between the malleolus and the calcaneal tendon. Under abductor hallucis it divides into the medial and lateral plantar arteries. The lateral plantar artery forms the deep plantar arch with the deep plantar branch of the dorsalis pedis artery.

Anatomy

Branches: The circumflex fibular artery (which may arise from the anterior tibial artery), the fibular artery, the nutrient artery of the tibia, muscular branches, medial malleolar and calcaneal branches, and the medial and lateral plantar arteries.

Function

Supplies the posterior compartment of the leg, the tibia, the heel and the sole of the foot.

Clinical significance

Pulse examination

Feeling the posterior tibial and dorsalis pedis pulses is a key part of examining a patient with peripheral arterial disease or diabetes. The posterior tibial pulse is much less often congenitally absent than the dorsalis pedis pulse.

Tarsal tunnel syndrome

In tarsal tunnel syndrome, the tibial nerve is compressed in the tunnel alongside the artery. This causes burning pain and tingling in the sole.

Mnemonics

Tarsal tunnel order (front to back)

"Tom, Dick And Very Nervous Harry": Tibialis posterior, flexor Digitorum longus, Artery, Vein, Nerve, flexor Hallucis longus.

Compiled from standard anatomy and physiology references — see the Cardiovascular System sources. For education only; not medical advice.