ArticleSurgical and radiologic anatomy : SRA2026
Terminal branching pattern of posterior tibial artery in the tarsal tunnel: a cadaveric study with its clinical importance in medial ankle surgeries.
Article in Surgical and radiologic anatomy : SRA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeThe posterior tibial artery (PTA) branching within the tarsal tunnel is subject to significant anatomical variation, which can complicate surgical procedures such as tarsal tunnel decompression, flap harvesting, and medial ankle fixation. This study aimed to quantify the morphometry of the PTA bifurcation relative to the Dellon-McKinnon malleolar-calcaneal line (DML) in order to define vascular "safe zones."
methodsTwenty-five formalin-fixed adult cadaveric limbs were dissected. The bifurcation of the PTA into the medial and lateral plantar arteries was identified. Measurements were taken in cm with the help of digital vernier calipers and angle with the help of goniometer. The following measurements included the bifurcation level relative to the DML (superior to, at, or inferior to), the distance from the DML, the bifurcation angle, and total foot length. The SSPS software was used for data analysis. Descriptive statistics were conducted for all the parameters. Correlation analysis was done to check for any association between foot length and artery branching length and artery branching angle. Spearman's Rank Correlation was done to check for the correlation between foot length and the medial and lateral plantar artery lengths. To establish whether there is any difference in foot length, angle of bifurcation, and distance of bifurcation from DML between limbs whose PTA divides superior to and inferior to the DML we have used an independent samples t- test.
resultsThe PTA bifurcated superior to the DML in 52%, at the level of the DML in 28%, and inferior to the DML in 20% of specimens. The mean bifurcation angle was 22.60°. A strong positive correlation was found between foot length and angle of division below the DML line, but it was not significant. (r = 0.516, p value-0.374). Rare variations, including arterial trifurcation and early anastomosis, were documented.
conclusionThe majority of PTA bifurcations occur proximal to or at the level of the DML. This high prevalence of proximal branching suggests that surgical incisions for medial ankle exposure are statistically safer when positioned at or distal to the DML to avoid iatrogenic arterial trauma.
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