Branches of the Posterior Tibial Artery
The posterior tibial artery divides into two terminal branches—the medial plantar artery and the lateral plantar artery—which supply distinct portions of the plantar foot. 1
Primary Terminal Branches
The posterior tibial artery bifurcates (most commonly at or just proximal to the tarsal tunnel level) into:
- Medial plantar artery - supplies the medial portion of the plantar foot
- Lateral plantar artery - supplies the lateral portion of the plantar foot
These terminal branches are part of the infrapopliteal arterial system that includes the tibial-peroneal trunk, anterior tibial artery, posterior tibial artery, peroneal artery, plantar pedal loop, and pedal vessels (common plantar, medial plantar, and lateral plantar arteries). 1
Anatomical Course and Bifurcation Pattern
The posterior tibial artery courses through the tarsal tunnel behind the medial malleolus of the ankle, where its pulse can be palpated. 2 Research demonstrates that the bifurcation location varies:
- 52% bifurcate superior to the malleolar-calcaneal line
- 28% bifurcate at the level of this line
- 20% bifurcate inferior to this line 3
The mean bifurcation angle between the medial and lateral plantar arteries is approximately 22.6°. 3
Additional Branches Along Its Course
While the guideline evidence focuses on the terminal branches, anatomical research identifies that the posterior tibial artery may give off additional smaller branches along its course before its terminal bifurcation, though these are not consistently named in the clinical guidelines. 4
Clinical Significance
Understanding this branching pattern is critical for:
- Angiosome-based revascularization - Each branch supplies a specific anatomic territory of skin and deep tissues in the foot 1
- Surgical planning - The bifurcation location relative to the medial malleolus determines safe zones for incisions during tarsal tunnel surgery, medial ankle fixation, and flap harvesting 3, 5
- Limb salvage procedures - In chronic limb-threatening ischemia (CLTI), direct revascularization to the appropriate posterior tibial artery branch feeding the wound angiosome improves outcomes 6
Anatomical Variations
Variations in posterior tibial artery branching occur in approximately 56% of cases 4, including:
- Trifurcation patterns (rather than bifurcation)
- Early anastomotic connections
- Anomalous dual posterior tibial arteries (rare) 7
- Variable distances of bifurcation from anatomical landmarks 3, 5
These variations emphasize the importance of preoperative vascular mapping with Doppler examination or imaging before surgical interventions in the foot and ankle region. 6