Anterior tibial artery

Course

The anterior tibial artery originates from the popliteal artery near the inferior border of the popliteus muscle. During its short course through the posterior compartment of the leg, the anterior tibial artery runs anteriorly between the heads of the tibialis posterior muscle. It then passes through the oval aperture in the proximal part of the interosseous membrane and runs medial to the fibular neck, emerging on the anterior compartment of the leg.

From here, it descends vertically down the anterior aspect of the interosseous membrane towards the distal tibia. Upon reaching the ankle joint, it terminates at the anterior surface of the tibia midway between the medial and lateral malleoli, and is continued by the dorsalis pedis artery.

Relations

Along its course in the posterior compartment of the leg, the anterior tibial artery is found between the heads of the tibialis posterior muscle. Upon its entry in the anterior compartment, the anterior tibial artery runs medially alongside the deep fibular (peroneal) nerve.

The proximal two-thirds of the anterior tibial artery run along the anterior aspect of the interosseous membrane of the leg and are covered by adjoining muscles and deep fascia. The upper third of the artery courses between the tibialis anterior and extensor digitorum longus muscles, while the middle third runs between the tibialis anterior and extensor hallucis longus muscles. The distal third of the artery runs along the anterior surface of the tibia and is covered by the skin, fasciae and extensor retinaculum. At the level of the ankle joint, the artery is crossed by the tendon of extensor hallucis longus. Further distally, it lies in between this tendon and the second tendon of the extensor digitorum longus muscle.

Branches and supply

The anterior tibial artery gives off several branches during its course; the posterior and anterior recurrent tibial, muscular, perforating, and anterior medial and lateral malleolar branches.

• Posterior recurrent tibial artery: arises from the anterior tibial artery soon after its origin, while it is still in the posterior compartment of the leg. The posterior recurrent tibial artery courses superiorly, anterior to the popliteus muscle. It travels with the recurrent nerve to popliteus and anastomoses with the inferior genicular branches of the popliteal artery. The posterior recurrent tibial artery supplies the superior tibiofibular joint.
• Anterior recurrent tibial artery: arises near the origin of the posterior recurrent tibial artery and shortly after, it pierces the tibialis anterior muscle. It gives off several branches anterior and lateral to the knee joint which anastomose with the genicular branches of the popliteal and circumflex fibular arteries, forming the patellar arterial network.
• Muscular branches: arise as multiple branches that supply the muscles of the anterior compartment. Some of these branches pierce the deep fascia and supply the skin of the anterior leg, while others pass through the interosseous membrane and anastomose with branches of the posterior tibial and fibular (peroneal) arteries.
• Perforating branches: pass behind the extensor digitorum longus muscle, piercing the deep fascia and supplying the skin of the anterior leg.
• Anterior medial malleolar artery: arises approximately 5 cm proximal to the ankle joint and courses posterior to the tendons of the extensor hallucis longus and tibialis anterior muscle. Upon reaching the medial side of the ankle, it gives off branches to supply the joint, which anastomose with branches of the posterior tibial and medial plantar arteries.
• Anterior lateral malleolar artery: courses posterior to the tendons of extensor digitorum longus and fibularis tertius muscles towards the lateral side of the ankle. Here, it gives off branches that supply the joint and anastomose with the perforating branch of the fibular (peroneal) artery, and the ascending branches of the lateral tarsal artery.

The anterior tibial artery terminates at the level of the ankle joint as the dorsalis pedis artery. The dorsalis pedis artery passes lateral to extensor hallucis longus onto the dorsum of the foot, and is the main artery that supplies this region of the foot.

Anatomical variations

The anterior tibial artery can have several anatomical variations concerning its origin, calibre, course and termination.

• The anterior tibial artery may occasionally be of small calibre or rarely, absent. In this case its supply is functionally replaced by the perforating branches of the posterior tibial artery or by the perforating branch of the fibular (peroneal) artery.
• The anterior tibial artery may take on a different course, running along the lateral side of the leg, only to regain its anterior position at the level of the ankle joint.
• The anterior tibial artery may occasionally terminate before reaching the dorsum of the foot. In this case, the dorsalis pedis artery arises from one of the perforating branches of the fibular (peroneal) artery.
• The anterior tibial artery may occasionally be of large calibre, in which case it supplies both the dorsum of the foot and the plantar arch.

Test your knowledge on the main arteries of the lower limb with this quiz.