The deep plantar arch in humans constitution and topography

Abstract

The integrity of the various structures within the feet depends on their blood supply. Lesions of the feet often require revascularization, which if successful avoids the need for amputation. To provide greater anatomical detail to aid vascular surgery and imaging, the anatomy and constitution of the deep plantar arch was studied in 50 adult cadaveric feet. The arteries of the foot were injected with red neoprene latex and dissected under magnification. The deep plantar arch, present in all feet, was the result of anastomosis between the deep plantar artery and the deep branch of the lateral plantar artery. The deep plantar artery was predominant in 72% of specimens (Type I arches) and the lateral plantar artery in 22% (Type II), with the contribution being equal in 6% (Type III). The medial plantar artery contributed to the medial segment of the deep plantar arch by its deep branch in 12% of specimens. The distance between the deep plantar arch and each interdigital commissure was generally constant, averaging 29% of total foot length. The deep plantar arch was located in the middle third of the foot in all specimens, being in the distal part of this third in 90%. The deep plantar arch is, therefore formed mainly by the deep plantar artery, a branch of the dorsal artery of foot; its location can be estimated if foot length is known.

The Anatomy of the Plantar Arterial Arch

“…In the present study, like many (Gabrielli et al;Ozer et al;Vann, 2005;Anupama, 2008) studies previously, the plantar arterial arch was found to be highly variable. Firstly, the shape of the plantar arterial arch was grouped into 3 types.…”

“…Although several studies have addressed the arterial anatomy of the foot, a more detailed study of the arch and its branches, such as their morphological and morphometric variations, are scarcely documented (Ozer et al;Gabrielli et al;Kelikian & Sarrafian;Sidawy, 2006;Moore et al).…”

“…In addition, accurate knowledge of the arterial patterns and variations becomes necessary in reconstructive surgery involving donation of various parts of the foot. The archus plantaris (Schuenke et al, 2010), deep plantar arch (Ozer et al, 2005;Gabrielli et al, 2001), or more commonly referred to as the plantar arterial arch since it is formed from two plantar arteries (Feneis & Dauber, 2000), is the main source of arterial supply to the foot (Standring, 2009). It is generally accepted that the arterial supply of the foot involves a triple supply system i.e., the distributing arteries are the anterior tibial, posterior tibial and peroneal arteries, with the source of blood being derived from the external iliac artery (Standring).…”

Ischemic Ulcer Healing: Does Appropriate Flow Reconstruction Stand for All That We Need?

“…The presence of highly emergent anterior tibial artery or irregular tibial trifurcation was described in 5.6-6% cases [109][110], while anomalous origins of the dorsalis pedis artery were encountered in 4.3-6% presentations [109,111]. Aberrant first dorsal metatarsal artery and appended first toe dominant irrigation was described in 8.1% cases [112], parallel variants of the arcuate artery in 5% [113], and modified courses of the plantar arch and plantar arteries in 5% of presentations [114]. The intimate knowledge of these variants seems significant for the advised interventionist since wounddirected revascularization is planned [30,100].…”

“…They also seem to play a pivotal role in intentional "wound-directed" revascularization and appropriate tissue regeneration [35,[96][97][98]118]. These vessels assemble the foot arches, (acknowledging eventual 5-9% anatomical variations, Section 6.3) [108][109][110][111][112][113][114], the metatarsal perforators, the anterior communicants, and other sizable arterial-arterial branches such as the dorsal foot-to-plantar, or the peroneal-to-posterior tibial rescue heel collaterals (level III of perfusion) [35,101].…”