Topics

Topic

design image
Medial tarsal arteries

The medial tarsal arteries are small branches of the dorsalis pedis artery that supply the medial aspect of the foot. Typically, there are two to three medial tarsal arteries, which arise anterior to the ankle joint and course medially over the medial tarsal bones (navicular and medial cuneiform). These arteries form part of the medial malleolar and tarsal anastomotic networks, contributing to collateral circulation around the foot and ankle.

They play an important role in maintaining cutaneous perfusion and osseous vascularity of the medial foot, particularly in patients with peripheral arterial disease or post-reconstructive flap surgeries.

Synonyms

  • Medial tarsal branches of the dorsalis pedis artery

  • Medial foot arterial branches

  • Medial tarsal perforating arteries

Origin, Course, and Distribution

  • Origin: Arise from the dorsalis pedis artery on the dorsum of the foot, anterior to the ankle joint

  • Course: Run medially across the tarsal bones (especially the navicular and medial cuneiform), deep to the tendons of the extensor hallucis longus and tibialis anterior

  • Distribution: Supply the medial side of the foot, contributing to the medial malleolar arterial network and medial plantar region through anastomoses with branches of the posterior tibial and medial plantar arteries

Relations

  • Anteriorly: Dorsalis pedis artery

  • Posteriorly: Navicular bone and medial cuneiform

  • Medially: Tibialis anterior tendon and medial malleolus

  • Laterally: Extensor hallucis longus tendon and dorsalis pedis artery trunk

  • Inferiorly: Medial tarsal fascia and dorsal foot muscles

Function

  • Arterial supply: Provides blood to the medial tarsal region, including skin, fascia, and tarsal bones

  • Collateral circulation: Contributes to the medial malleolar arterial anastomosis and dorsal-plantar communication

  • Nutrient role: Supports periosteal and cutaneous vascularization essential for wound healing and flap viability

  • Clinical importance: Preservation is crucial during medial foot or ankle surgeries and reconstructive procedures

Arterial Supply (Origin Connections)

  • Primary source: Dorsalis pedis artery

  • Anastomoses with:

    • Medial malleolar branches of the posterior tibial artery

    • Medial plantar artery

    • Arcuate artery (dorsal network)

Clinical Significance

  • Vascular compromise: May be affected in diabetes, trauma, or peripheral arterial disease, leading to ischemia of the medial foot

  • Surgical relevance: Important landmark during flap harvests, bypass grafting, and reconstructive surgeries around the ankle and dorsum of the foot

  • Atherosclerosis/occlusion: Rare but may contribute to localized ischemia or delayed wound healing

  • Imaging role: Crucial for assessing arterial patency, flow dynamics, and collateralization in ischemic foot evaluation

MRI Appearance

  • T1-weighted images:

    • Normal medial tarsal arteries appear as flow voids (black linear structures) surrounded by intermediate signal muscle and fat.

    • Adjacent fat and soft tissues appear bright, enhancing vessel contrast.

    • Thrombosed or occluded arteries may lose normal flow void appearance and show intermediate intraluminal signal.

  • T2-weighted images:

    • Flowing blood: low-to-absent signal (flow void)

    • Vessel wall thickening or slow flow: intermediate signal intensity

    • Perivascular inflammation: mild hyperintensity in surrounding soft tissues.

  • STIR:

    • Vessel lumen: remains dark (flow void)

    • Perivascular edema or inflammation: bright hyperintense signal outlining vessel course.

  • Proton Density Fat-Saturated (PD FS):

    • Normal arteries: dark linear structures within the dorsal foot fat plane

    • Occlusion or inflammation: focal bright signal may indicate vessel wall thickening or thrombosis.

  • T1 Fat-Sat Post-Contrast (Axial):

    • Normal: sharp linear enhancement of vessel lumen due to contrast opacification.

    • Arterial wall: smooth, well-defined margins.

    • Pathology: focal or segmental absence of enhancement suggests thrombosis or occlusion; irregular enhancement may reflect arteritis or plaque.

MR Angiography (Contrast-Enhanced MRA)

  • Provides three-dimensional visualization of the dorsalis pedis and its medial tarsal branches.

  • Normal MRA:

    • Medial tarsal arteries show fine, continuous enhancing channels extending medially from dorsalis pedis.

    • Smooth lumen with uniform enhancement indicates patency.

  • Pathological findings:

    • Tapered narrowing or signal loss: stenosis or atherosclerotic changes.

    • Complete cutoff or non-opacification: occlusion or embolism.

    • Wall irregularity or mural thickening: suggests arteritis or post-traumatic intimal damage.

CT Appearance

Non-Contrast CT:

  • Arteries not directly visible unless calcified (appearing as small linear hyperdensities).

  • Adjacent tarsal bones and fat planes define regional anatomy.

Post-Contrast CT (CTA):

  • Normal CTA:

    • Medial tarsal arteries enhance as thin continuous opacified channels extending medially from dorsalis pedis artery.

    • Visualized best in axial and coronal reconstructions.

    • Clear depiction of branching pattern and anastomoses with posterior tibial and medial plantar arteries.

  • Pathological CTA findings:

    • Non-opacified or interrupted segments: occlusion or spasm.

    • Irregular or narrowed lumen: atherosclerosis or plaque buildup.

    • Collateral vessels: indicate chronic obstruction.

    • Perivascular enhancement: may suggest inflammation or infection.

MRI images

Medial tarsal arteries axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI images

Medial tarsal arteries axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000_00001

MRI images

Medial tarsal arteries axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000_00002

CT images

Medial tarsal arteries ct axial