Fibular (peroneal) artery

Course

The fibular artery arises from the posterior tibial artery usually about 2.5 cm below the popliteus muscle, but it may occasionally arise up to 8 cm distal to the popliteus. Some texts may describe the fibular artery as arising from a vessel known as the tibiofibular trunk (or tibioperoneal trunk), which is an alternative title for the proximal part of the posterior tibial artery. 

From its origin point, the fibular artery descends obliquely along the medial crest of the fibula. It usually courses within the flexor hallucis longus muscle, or in a fibrous canal formed between the tibialis posterior and flexor hallucis longus muscles. Proximally, the fibular artery is covered by the soleus muscle and the transverse intermuscular septum, while the flexor hallucis longus muscle covers its distal portion.

As it reaches the tibiofibular syndesmosis, the fibular artery ends by dividing into its terminal branches.

Branches and supply

Along its course, the fibular artery gives off several branches; muscular, nutrient, perforating, communicating and calcaneal branches.

• Muscular branches: arise as several short branches that supply the muscles of the deep posterior and lateral compartments of the leg. These include the popliteus, soleus, tibialis posterior, and flexor hallucis longus muscles.
• Nutrient artery of fibula: arises from the fibular artery roughly 7 cm after its origin and pierces the fibula at its medial crest, near the middle third of the bone shaft, providing it with endosteal supply.
• Perforating branches: arise as several branches, usually around 5-7. Out of all of them, one branch is usually of a larger caliber. This branch pierces the distal interosseous membrane proximal to the lateral malleolus to enter the anterior compartment of the leg. Here, it anastomoses with the anterior lateral malleolar branch of the anterior tibial artery. The perforating branch then passes to the dorsum of the foot where it supplies the tarsus and anastomoses with the lateral tarsal artery. Other perforating branches pierce the deep fascia and supply the skin of the posterolateral leg.
• Posterior lateral malleolar branch: surrounds the lateral malleolus and anastomoses with other malleolar arteries, contributing to the lateral malleolar vascular network.
• Communicating branch: anastomoses with a communicating branch of the posterior tibial artery about 5 cm proximal to the ankle.
• Calcaneal branches: arise as terminal branches of the fibular artery and pass to the lateral side of the calcaneus to anastomose with the calcaneal branches of the posterior tibial artery. They supply the skin over the lateral side of the calcaneal tendon and the calcaneus.