Henry Gray (18251861). Anatomy of the Human Body. 1918.
tendons of the Tibialis posterior and Flexor digitorum longus, lying in the same groove, behind the malleolus, the former being the more medial. Next is the posterior tibial artery, with a vein on either side of it; and lateral to the vessels is the tibial nerve; about 1.25 cm. nearer the heel is the tendon of the Flexor hallucis longus.
Peculiarities in Size.The posterior tibial is not infrequently smaller than usual, or absent, its place being supplied by a large peroneal artery, which either joins the small posterior tibial artery, or continues alone to the sole of the foot.
Branches.The branches of the posterior tibial artery are:
Posterior Medial Malleolar.
The peroneal artery (a. peronæa) is deeply seated on the back of the fibular side of the leg. It arises from the posterior tibial, about 2.5 cm. below the lower border of the Popliteus, passes obliquely toward the fibula, and then descends along the medial side of that bone, contained in a fibrous canal between the Tibialis posterior and the Flexor hallucis longus, or in the substance of the latter muscle. It then runs behind the tibiofibular syndesmosis and divides into lateral calcaneal branches which ramify on the lateral and posterior surfaces of the calcaneus.
It is covered, in the upper part of its course, by the Soleus and deep transverse fascia of the leg; below, by the Flexor hallucis longus.
Peculiarities in Origin.The peroneal artery may arise 7 or 8 cm. below the Popliteus, or from the posterior tibial high up, or even from the popliteal.
Its size is more frequently increased than diminished; and then it either reinforces the posterior tibial by its junction with it, or altogether takes the place of the posterior tibial in the lower part of the leg and foot, the latter vessel only existing as a short muscular branch. In those rare cases where the peroneal artery is smaller than usual, a branch from the posterior tibial supplies its place; and a branch from the anterior tibial compensates for the diminished anterior peroneal artery. In one case the peroneal artery was entirely wanting.
Branches.The branches of the peroneal are:
Muscular Branches.The peroneal artery, in its course, gives off branches to the Soleus, Tibialis posterior, Flexor hallucis longus, and Peronei.
The Nutrient Artery (a. nutricia fibulæ) supplies the fibula, and is directed downward.
The Perforating Branch (ramus perforans; anterior peroneal artery) pierces the interosseous membrane, about 5 cm. above the lateral malleolus, to reach the front of the leg, where it anastomoses with the anterior lateral malleolar; it then passes down in front of the tibiofibular syndesmosis, gives branches to the tarsus, and anastomoses with the lateral tarsal. The perforating branch is sometimes enlarged, and takes the place of the dorsalis pedis artery.
The Communicating Branch (ramus communicans) is given off from the peroneal about 2.5 cm. from its lower end, and joins the communicating branch of the posterior tibial.
The Lateral Calcaneal (ramus calcaneus lateralis; external calcaneal) are the terminal branches of the peroneal artery; they pass to the lateral side of the heel, and communicate with the lateral malleolar and, on the back of the heel, with the medial calcaneal arteries.
The nutrient artery (a. nutricia tibiæ) of the tibia arises from the posterior tibial, near its origin, and after supplying a few muscular branches enters the nutrient canal of the bone, which it traverses obliquely from above downward. This is the largest nutrient artery of bone in the body.