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Dorsal metatarsal arteries

The dorsal metatarsal arteries (DMAs) are small but vital vessels supplying the dorsum of the foot and dorsal aspects of the toes. Typically, there are four dorsal metatarsal arteries arising from the arcuate artery, a branch of the dorsalis pedis artery. They run forward in the second to fourth intermetatarsal spaces, deep to the tendons of the extensor digitorum longus, and form an essential component of the foot’s arterial network by connecting dorsal and plantar circulations.

These arteries play a crucial role in digital perfusion, thermoregulation, and wound healing, and are often visualized during CT angiography and Doppler ultrasound for vascular assessment in peripheral artery disease or diabetic foot evaluation.

Synonyms

  • Metatarsal arteries of the dorsum of the foot

  • Arteriae metatarsales dorsales

  • Dorsal digital arteries (proximal segments)

Origin, Course, and Branches

  • Origin: The first through fourth dorsal metatarsal arteries usually arise from the arcuate artery, which is a branch of the dorsalis pedis artery.

    • The first dorsal metatarsal artery may arise directly from the dorsalis pedis artery before it becomes the arcuate artery.

  • Course:

    • Each artery runs anteriorly along the intermetatarsal spaces between the corresponding metatarsal bones.

    • They course deep to the extensor tendons, lying on the dorsal interossei muscles.

  • Branches:

    • Near the metatarsal heads, each divides into two dorsal digital arteries supplying adjacent sides of the toes.

    • Each dorsal metatarsal artery also gives off perforating branches that pass through the interosseous spaces to anastomose with the plantar metatarsal arteries.

Relations

  • Superficially: Tendons of extensor digitorum longus and brevis

  • Deeply: Dorsal interosseous muscles and metatarsal bones

  • Medially: Dorsalis pedis artery and deep peroneal nerve (in proximal segments)

  • Laterally: Arcuate artery and dorsal venous network

Arterial Supply

  • Main source: Dorsalis pedis artery → arcuate artery → dorsal metatarsal arteries

  • Additional contributions: From perforating branches of plantar metatarsal arteries through interosseous anastomoses

  • Anastomoses: Extensive communication with plantar arch and digital arteries ensures collateral circulation to the toes

Function

  • Perfusion of dorsal foot: Supplies skin, fascia, and extensor tendons of the dorsum

  • Toe circulation: Provides blood to dorsal aspects of the toes via dorsal digital branches

  • Anastomotic role: Links the dorsal and plantar arterial networks, maintaining perfusion in cases of obstruction

  • Clinical importance: Crucial in flap surgery, ischemic wound healing, and vascular grafting in foot reconstruction

Clinical Significance

  • Peripheral artery disease: Commonly evaluated for stenosis or occlusion in diabetic foot patients

  • Trauma: Injury may cause ischemia or delayed wound healing over the dorsum of the foot

  • Bypass and flap planning: Used as recipient vessels in microvascular reconstructive procedures

  • Imaging relevance: Critical landmarks in angiography, CT angiography, and MR angiography of the foot

MRI Appearance

  • T1-weighted images:

    • Arteries appear as tubular flow voids (dark structures) due to fast-flowing blood

    • Surrounding fat: bright signal outlining vessel walls

    • Thrombosed or occluded arteries: loss of flow void with intermediate signal within lumen

  • T2-weighted images:

    • Flowing blood maintains signal void (black linear appearance)

    • Slow or turbulent flow may cause variable intermediate-to-bright signal within the lumen

    • Vessel walls: thin and indistinct in normal state, thickened or irregular in arteritis or atherosclerosis

  • STIR:

    • Normal arteries: dark-to-intermediate signal

    • Edematous or inflamed surrounding tissues: bright hyperintensity (seen in cellulitis, vasculitis, or trauma)

  • Proton Density Fat-Saturated (PD FS):

    • Arteries: dark luminal signal with bright surrounding fat-suppressed tissues

    • Helpful for identifying periarterial edema or inflammatory changes

    • Thrombosis: shows intermediate to high signal within the vessel lumen

  • T1 Fat-Sat Post-Contrast (MRA):

    • Arteries enhance brightly and sharply after gadolinium administration

    • Provides excellent depiction of course, caliber, and anastomoses

    • Areas of stenosis or occlusion: loss of enhancement or irregular narrowing

CT Appearance

Non-Contrast CT:

  • Arteries not well visualized unless calcified

  • Arterial calcifications along metatarsal spaces may indicate atherosclerosis

  • Surrounding soft tissue: homogeneous density with visible intermetatarsal fat

CT Angiography (Post-Contrast):

  • Dorsal metatarsal arteries appear as bright contrast-filled linear structures coursing between metatarsals

  • Clearly demonstrates arterial branching, continuity, and digital bifurcations

  • Stenosis or occlusion: seen as luminal narrowing or contrast interruption

  • Aneurysm or pseudoaneurysm: focal contrast outpouching along arterial course

  • Perforating branches: visible connecting dorsal and plantar networks

MRI image

Dorsal metatarsal arteries of foot sfov of the Foot axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI image

Dorsal metatarsal arteries of foot sfov of the Foot axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000_00001

CT image

Dorsal metatarsal arteries ct axial