Arteries of the lower extremities

The arterial supply of the lower extremity originates from the external iliac artery and provides oxygenated blood to the pelvis, thigh, leg, and foot. A clear understanding of the course, branches, and clinical significance of these arteries is essential for anatomical study and clinical application (e.g., trauma, claudication, bypass surgeries).

Overview

The main arterial pathway to the lower limb:

Abdominal aorta → Common iliac artery → External iliac artery → Femoral artery → Popliteal artery → Anterior and Posterior tibial arteries → Plantar and dorsalis pedis arteries

External Iliac Artery

Origin

• Continuation of the common iliac artery, begins at the level of the sacroiliac joint.

Course

• Travels along the pelvic brim and passes under the inguinal ligament, where it becomes the femoral artery.

Branches (before entering thigh)

• Inferior epigastric artery
• Deep circumflex iliac artery

Femoral Artery

Location

• Begins at the inguinal ligament and runs in the femoral triangle and adductor canal.

Surface Anatomy

• Palpable midway between ASIS and pubic symphysis.

Branches

• Superficial branches:
  • Superficial epigastric
  • Superficial circumflex iliac
  • Superficial external pudendal
• Deep branches:
  • Profunda femoris artery (deep artery of thigh):
    • Medial circumflex femoral artery
    • Lateral circumflex femoral artery
    • Perforating arteries (3–4)

Termination

• Passes through the adductor hiatus to become the popliteal artery.

Popliteal Artery

Location

• Continuation of the femoral artery after passing through the adductor hiatus.
• Lies in the popliteal fossa, posterior to the knee.

Branches

• Genicular branches: Contribute to the genicular anastomosis around the knee.
• Muscular branches
• Divides into:
  • Anterior tibial artery
  • Posterior tibial artery

Anterior Tibial Artery

Course

• Passes through the interosseous membrane to enter the anterior compartment of the leg.
• Runs along the anterior leg between tibialis anterior and extensor muscles.

Branches

• Anterior tibial recurrent artery
• Muscular branches
• Medial and lateral malleolar arteries

Termination

• Continues as dorsalis pedis artery on the dorsum of the foot.

Dorsalis Pedis Artery

Location

• Runs over the dorsum of the foot, lateral to the tendon of extensor hallucis longus.

Branches

• Lateral tarsal artery
• Arcuate artery
• First dorsal metatarsal artery
• Deep plantar artery: Joins the deep plantar arch (with lateral plantar artery)

Clinical Relevance

• Dorsalis pedis pulse is palpable on the dorsum of the foot.

Posterior Tibial Artery

Course

• Travels in the posterior compartment, deep to soleus, and behind the medial malleolus.

Branches

• Fibular (peroneal) artery
• Nutrient artery of the tibia
• Medial malleolar branches
• Calcaneal branches

Termination

• Divides into:
  • Medial plantar artery
  • Lateral plantar artery (forms the deep plantar arch)

Fibular (Peroneal) Artery

Origin

• Branch of the posterior tibial artery.

Course

• Descends in the lateral part of the posterior compartment, behind the fibula.

Branches

• Perforating branch: Anastomoses with anterior tibial artery
• Communicating branch
• Calcaneal branches

Plantar Arteries (Sole of Foot)

Medial Plantar Artery

• Smaller branch
• Supplies medial side of sole and great toe

Lateral Plantar Artery

• Larger branch
• Forms plantar arterial arch (with deep plantar artery from dorsalis pedis)

Plantar Arch

• Gives rise to:
  • Plantar metatarsal arteries
  • Plantar digital arteries

Clinical Relevance

• Peripheral artery disease (PAD): Common in femoral or popliteal arteries; causes claudication.
• Pulses:
  • Femoral pulse: Mid-inguinal point
  • Popliteal pulse: Deep in popliteal fossa
  • Posterior tibial pulse: Behind medial malleolus
  • Dorsalis pedis pulse: Lateral to extensor hallucis longus tendon
• Arterial injury: Trauma to popliteal fossa can damage popliteal artery → limb ischemia.
• Bypass grafting often uses femoral artery as an access point.

References

• Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy.
• Drake RL et al. Gray's Anatomy for Students.
• Netter FH. Atlas of Human Anatomy.
• Kenhub: Lower limb arteries and nerves