Dorsalis pedis artery

Course

The dorsalis pedis artery begins just distal to the superior band of the inferior extensor retinaculum, at the midpoint of the medial and lateral malleoli. It takes an oblique path medially, coursing along the dorsal surfaces of the talus, navicular and intermediate cuneiform bones, reaching the proximal aspect of the first intermetatarsal space.

Here, the artery gives off the first dorsal metatarsal branch and continues as the deep plantar artery. The deep plantar artery dives between the heads of the first dorsal interosseous muscle into the sole of the foot. It anastomoses with the lateral plantar artery (from the posterior tibial artery) to form the deep plantar arch. Along its path, the dorsalis pedis artery is accompanied by the medial branch of the deep fibular (peroneal) nerve, which lies lateral to it.

Branches and supply

The dorsalis pedis artery typically has four major branches;

• The lateral tarsal artery arises from the dorsalis pedis artery as it courses over the navicular bone. From its origin, the artery travels laterally, passing deep to the extensor digitorum brevis muscle and supplying this muscle. Additionally, the lateral tarsal artery supplies adjacent tarsal bones and joints. The lateral tarsal artery forms an anastomotic network with other branches around the ankle including the arcuate artery and the anterior lateral malleolar artery (from the anterior tibial artery).
• The medial tarsal arteries are usually two or three arteries that stem from the dorsalis pedis artery. The arteries course medially, passing behind the extensor hallucis longus tendon. They supply structures on the medial aspect of the ankle and midfoot including the tarsal bones and joints. The arteries form anastomoses with the medial malleolar network.
• The arcuate artery arises close to the medial cuneiform bone and travels laterally, behind the digital extensor tendons. It courses over the bases of the second to fifth metatarsals and typically anastomoses with the lateral tarsal artery, forming an arterial loop. The artery gives rise to the second to fourth dorsal metatarsal arteries which pass superficial to the dorsal interossei muscles, supplying these muscles and adjacent metatarsal bones. Further distally, each dorsal metatarsal artery divides into two dorsal digital arteries to supply adjacent sides of digits 2 to 5.
• The first dorsal metatarsal artery is the last branch of the dorsalis pedis artery that usually emerges at the base of the first and second metatarsals, just before the dorsalis pedis becomes the deep plantar artery. It travels along the superior surface of the first dorsal interosseous muscle. Along its distal course, the first dorsal metatarsal artery gives off a dorsal digital branch that passes behind the extensor hallucis longus tendon to supply the medial aspect of the great toe. At the cleft of the first and second toes, the first dorsal metatarsal artery splits to supply the lateral side of the great toe and the medial side of the second toe.

Due to its superficial location, the dorsalis pedis artery gives off small direct cutaneous branches which supply the skin of the dorsum of the foot.

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Anatomical variations

Several anatomical variations of the dorsalis pedis artery have been noted in the literature regarding its origin, course, calibre, branches and its complete absence. Majority of these variations are, however, uncommon.

The dorsalis pedis artery is predominantly a continuation of the anterior tibial artery, however, in a few cases it is completely absent and replaced by a perforating branch of the fibular (peroneal) artery.