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Plantar metatarsal arteries

The plantar metatarsal arteries (PMAs) are four slender arteries located in the sole of the foot, forming the primary arterial supply to the metatarsal spaces and toes. They arise from the deep plantar arch, which is the terminal continuation of the lateral plantar artery (with contribution from the dorsalis pedis artery via the deep plantar branch).

The plantar metatarsal arteries run distally between the metatarsal bones, deep to the interosseous muscles, and divide into the common plantar digital arteries, which further bifurcate into proper plantar digital arteries to supply the toes. These arteries play a vital role in maintaining forefoot perfusion, plantar tissue viability, and digital oxygenation.

Synonyms

  • Arteriae metatarsales plantares

  • Plantar intermetatarsal arteries

  • Metatarsal branches of the deep plantar arch

Origin, Course, and Branches

  • Origin: Arise from the deep plantar arterial arch, which is formed by the lateral plantar artery and the deep plantar branch of the dorsalis pedis artery.

  • Course: Each plantar metatarsal artery passes anteriorly between adjacent metatarsal bones, deep to the interosseous muscles, and accompanied by corresponding plantar metatarsal veins.

  • Branches:

    • Perforating branches: Communicate with the dorsal metatarsal arteries through small perforators in the intermetatarsal spaces.

    • Common plantar digital arteries: Terminal branches that divide into proper plantar digital arteries for adjacent toes.

    • Cutaneous and muscular branches: Supply plantar skin, interossei, and lumbricals.

Relations

  • Superiorly: Interosseous muscles and metatarsal bones

  • Inferiorly: Plantar aponeurosis and superficial fascia

  • Medially: Medial plantar artery and nerve

  • Laterally: Lateral plantar artery and nerve

  • Anteriorly: Common plantar digital arteries

  • Posteriorly: Deep plantar arch and lateral plantar artery origin

Arterial Supply

  • Source: Deep plantar arch (continuation of lateral plantar artery and deep plantar branch of dorsalis pedis)

  • Distribution: Toes, interosseous muscles, lumbricals, plantar skin, and soft tissue of the forefoot

Function

  • Nutrient supply: Provides oxygenated blood to the plantar aspect of the forefoot and toes

  • Anastomotic connection: Links dorsal and plantar arterial systems, ensuring collateral perfusion

  • Tissue viability: Maintains vitality of metatarsal and digital tissues, crucial for wound healing

  • Thermoregulation: Participates in heat exchange and temperature regulation of the plantar surface

Clinical Significance

  • Peripheral arterial disease (PAD): PMAs are frequently affected in diabetic foot ischemia and atherosclerosis, leading to tissue necrosis or ulceration

  • Angiographic relevance: Commonly evaluated in pedal bypass grafting and angioplasty planning

  • Surgical anatomy: Knowledge crucial in flap designs (e.g., plantar metatarsal flaps) and reconstructive microsurgery

  • Trauma or iatrogenic injury: May result in ischemia or necrosis of adjacent toes

  • Imaging relevance: MRI and CT angiography are key modalities for assessing vessel patency and pathology

MRI Appearance

  • T1-weighted images:

    • Normal arteries appear as flow voids (black linear structures) surrounded by bright perivascular fat.

    • Slow flow or partial thrombosis may produce intermediate signal intensity.

    • Adjacent soft tissues and muscle show intermediate signal; fat planes are bright.

  • T2-weighted images:

    • Normal arteries: flow voids (dark linear signals) within bright surrounding muscle and fat.

    • Turbulent or slow flow: focal hyperintensity within lumen.

    • Thrombosed or occluded arteries show loss of flow void and may appear slightly hyperintense.

  • STIR:

    • Normal vessels: intermediate-to-dark signal due to flow void.

    • Inflammation or perivascular edema: bright hyperintensity around arterial wall.

    • Useful for detecting vasculitis or soft-tissue inflammation adjacent to arteries.

  • Proton Density Fat-Saturated (PD FS):

    • Normal arteries: dark linear flow voids with sharp margins.

    • Pathology: bright mural signal if thrombus or wall thickening is present.

    • Best for visualizing adjacent muscle edema or small vessel inflammation.

  • T1 Fat-Sat Post-Contrast:

    • Normal arteries: strong linear enhancement corresponding to opacified lumen.

    • Occlusion: absence of enhancement with non-enhancing filling defect.

    • Wall thickening or inflammatory arteritis: ring-like or mural enhancement pattern.

    • Useful for differentiating occlusive disease, aneurysm, and inflammatory vasculopathy.

CT Appearance

Non-Contrast CT:

  • Plantar metatarsal arteries not easily visible without contrast.

  • May identify arterial wall calcifications in chronic atherosclerosis, particularly in diabetic patients.

  • Soft tissues of the sole and metatarsal spaces appear as homogeneous low-density structures.

CT Angiography (Post-Contrast):

  • Arteries appear as bright enhancing linear channels within the intermetatarsal spaces.

  • Each plantar metatarsal artery is clearly delineated, showing course and branching into digital arteries.

  • Occlusion: visualized as abrupt loss of enhancement or tapering.

  • Aneurysm or pseudoaneurysm: focal contrast-filled dilation.

  • Perivascular inflammation or edema: soft-tissue density with subtle enhancement surrounding artery.

  • Highly valuable for preoperative vascular mapping, diabetic foot evaluation, and reconstructive surgery planning.

MRI image

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

CT image

Plantar metatarsal arteries ct axial