Introduction
The vascular anatomy of the ankle is characterized by a rich and redundant arterial network that ensures adequate perfusion of the talus, distal tibia, fibula, and foot. This complex circulation plays a critical role in fracture healing, soft-tissue viability, and surgical safety.
The arterial supply of the ankle is derived primarily from three major vessels: the anterior tibial artery, posterior tibial artery, and peroneal (fibular) artery. These vessels form an extensive malleolar anastomotic network that provides collateral circulation and protects the distal limb from ischemia.
Anterior Tibial Artery
· Originates from the popliteal artery and passes through the interosseous membrane into the anterior compartment of the leg. It descends along the interosseous membrane, accompanied by the deep peroneal nerve.
· At the level of the ankle joint, the artery runs between the extensor hallucis longus and extensor digitorum longus tendons.
· It gives rise to the anterior medial and anterior lateral malleolar arteries, which contribute to the malleolar arterial network and supply the anterior ankle capsule and talar neck.
· The artery continues as the dorsalis pedis artery, supplying the dorsal foot.
· Injury to this vessel is clinically relevant during anterior ankle arthroscopy and talar neck fractures.
Posterior Tibial Artery
· The posterior tibial artery is the main vascular supply of the ankle and plantar foot.
· It courses through the deep posterior compartment and passes behind the medial malleolus within the tarsal tunnel.
· At the ankle level, it lies between the flexor digitorum longus and flexor hallucis longus tendons, accompanied by the tibial nerve.
· The artery gives off medial malleolar and calcaneal branches before dividing into the medial and lateral plantar arteries.
· Posterior tibial artery is particularly vulnerable during medial malleolar fractures and tarsal tunnel surgery.
Peroneal (Fibular) Artery
· The peroneal artery arises from the posterior tibial artery and descends along the posterior aspect of the fibula.
· The lateral ankle and hindfoot through lateral malleolar and calcaneal branches is supplied by Peronal Artery.
· İt plays a critical role in calcaneal and subtalar joint perfusion.
· Injury may occur during calcaneal fractures or posterolateral surgical approaches.
Malleolar Arterial Network This network provides collateral circulation and protects the ankle from ischemia following isolated arterial injury.
Clinical Correlations
• Medial malleolar fractures may compromise the posterior tibial artery.
• Talar neck fractures endanger branches of the anterior tibial artery.
• Calcaneal fractures may affect the peroneal artery.
• Knowledge of vascular anatomy is essential during ankle arthroscopy and reconstructive surgery.