Tibial Artery
Original Editor - Khloud Shreif
Top Contributors - Khloud Shreif
Description
Root
The superficial femoral artery as a major artery in the thigh, go down the leg, where it passes through an opening in adductor hiatus (opening between adductor magnus and femur). Then it enters the popliteal fossa at the back of the knee as a popliteal artery then divided into anterior tibial artery and posterior tibial artery.
Branches
The popliteal artery divided into: anterior tibial artery and the posterior tibial artery.
Then the anterior tibial artery: passes anterior to the popliteus muscles, through the interosseous membrane between the tibia and fibula, when it descends to the ankle it continues as a dorsalis pedis artery anterior to the ankle. In addition, it gives medial and lateral malleolar arteries, above the ankle joint, and the anterior tibial recurrent artery that supply the knee joint, this branch arises as just the tibial artery leave the popliteal fossa[1].
The posterior tibial artery: the largest terminal branch of the popliteal artery, passes in the deep posterior compartment of the leg with the tibial nerve between the tibialis posterior and flexor hallucis longus muscle, it can be palpable at the level of the ankle as it becomes to be more superficial posterior to the medial malleolus. At the foot the posterior tibial artery passes through the tarsal tunnel, it branches into the posterior medial malleolar artery and the artery of the tarsal tunnel, behind the medial malleolus branches into medial and lateral plantar arteries[2]. Above this, at the knee, it gives the peroneal artery branch just below the popliteus muscle, then travels over the tibialis posterior muscle [2].
Function
- Dorsalis pedis artery, the blood supply to the dorsal aspect of the foot
- Medial and lateral malleolar arteries, supply to the medial and lateral aspect of the ankle
- Anterior tibial recurrent artery, supply to the knee joint and its surrounding muscles
- Peroneal artery branch, supplies the lateral and posterior compartment of the leg
- Medial and lateral plantar arteries, supply to the sole of the foot
- Posterior medial malleolar artery, supply the medial of the ankle
- Artery of the tarsal tunnel, supply to talus body.
Clinical relevance
Acute compartment syndrome can result can after trauma like; blunt force injury, reperfusion injury (sudden restoration of blood flow back to the muscles after time of interrupted blood flow), and because of the tendency to cause severe damage, it is considered a surgical emergency[3].
Chronic compartment syndrome, excessive swelling of the muscles of the lower limb during exercise or physical activity, that develops gradually with repeated exercises[4].
When these muscles swell due to injury, the fascia does not stretch, leading to increased pressure within the compartment. This pressure can compress blood vessels, reducing blood flow to the muscles, which can cause muscle tissue to become ischemic (lacking oxygen). The nerves within the compartment can also be compressed, leading to a loss of muscle function and sensation[3].
Management
Surgical Management
Acute compartment syndrome is considered a surgical emergency. The most effective treatment is a fasciotomy, a procedure where the fascia is cut to relieve the pressure, the sooner it is performed, the better the outcome for the patient[3]. This procedure sometimes also used with chronic compartment syndrome.
Non-surgical Management
There are studies based on small case series that suggest using Botox injections in chronic compartment syndrome may help to reduce symptoms and more research is needed to confirm the effectiveness of these treatments and to find other possible nonoperative options[4].
Physical therapy intervention may include; massage, gait modifications, altering foot-strike patterns have been explored, using of kinesiotaping, and functional manual therapy[4].
Resources
This page Compartment Syndrome of the Lower Leg for more details about compartment syndrome assessment and treatment.
References
- ↑ Bereza T, Skrzat J, Mróz I, Pasternak A, Tomaszewski K, Mizia E, Kielczewski S, Pawlicki D, Kurzydło W, Bachul P, Konarska M. Blood vessels of the shin—anterior tibial artery—anatomy and embryology—own studies and review of the literature. Folia Medica Cracoviensia. 2016.
- ↑ 2.0 2.1 Chmielewski P, Warchoł Ł, Mróz I, Malczak M, Jaworek J, Mizia E, Walocha E, Depukat P, Bachul P, Bereza T, Kurzydło W. Blood vessels of the shin—posterior tibial artery—anatomy—own studiesand review of the literature. Folia Medica Cracoviensia. 2016(3).
- ↑ 3.0 3.1 3.2 Long B, Koyfman A, Gottlieb M. Evaluation and management of acute compartment syndrome in the emergency department. The Journal of emergency medicine. 2019 Apr 1;56(4):386-97.
- ↑ 4.0 4.1 4.2 Buerba RA, Fretes NF, Devana SK, Beck JJ. Chronic exertional compartment syndrome: current management strategies. Open access journal of sports medicine. 2019 May 23:71-9.