Topographic-anatomical characteristics of artery tibialis posterior and its branches in the area of ankle canal

AIM: To clarify peculiarities of the anatomy and topography of the plantar vessels in the area of the ankle canal, to justify access to the bifurcation of the artery tibialis posterior and ultrasound examination of the plantar arteries. The results of anatomical preparations of 10 amputated lower limbs, and of ultrasound duplex angioscanning (DUS) of 30 healthy volunteers without pathology of the vascular system performed using a linear transducer with frequency of 7–12 MHz, were studied. According to the data of anatomical preparation and ultrasound examination, the bifurcation level of the artery tibialis posterior was 1.7 ± 0.4 cm (min 0.5 cm — max 2 cm) below the level of the posterior edge of the medial ankle and was slightly covered by the musculus abductor hallucis. The average diameter of the artery tibialis posterior above the bifurcation level was 2.56 ± 0.4 mm, of the medial plantar artery 1.4 ± 0.44 mm, and of the lateral plantar artery 1.8 ± 0.5 mm. The lateral plantar artery was 90% larger in diameter than the medial plantar artery. In 7% of cases, the medial plantar artery was larger, and in 3% of cases, the diameters of both arteries were equal. When taking the bifurcation of the posterior tibial artery as the central point, the plantar vessels on the DUS can be traced distally down under the abdomen of the musculus abductor hallucis: the medial vessels lie more anteriorly at 2 o'clock position, and the lateral vessels lie somewhat posteriorly at 1 o'clock. Assessment of blood flow at this level gives an idea of the state of the foot vessels. The level of bifurcation of the artery tibialis posterior is located 1.7±0.4 cm below the posterior edge of the medial malleolus, which makes it possible to identify the location of access to it. The location of the DUS probe from this point at 2 oclock position corresponds to the projection of the medial plantar artery, at 1 oclock — to the lateral plantar artery on the right lower limb, on the left lower limb — at 10 and 11 oclock, respectively.