The dorsalis pedis artery runs from the middle of the front of the ankle to the base of the first metatarsal interspace. The extensor longus hallucis tendon is on the medial side and the extensor longus digitorum on the lateral. An incision made midway between these tendons exposes the muscular fibres of the extensor brevis digitorum; this is pulled to the outer side and the artery will be found lying on the bone beneath. The extensor brevis digitorum crosses it near its termination.

This artery is rarely the subject of ligation, but one frequently endeavors to feel its pulsation in order to determine whether the artery above is intact.

The Plantar Arteries

The tibialis posterior divides into the internal and external plantar arteries at a point midway on a line joining the internal malleolus and internal tubercle of the os calcis. From this point the internal plantar artery runs forward along the medial side of the flexor longus hallucis in the groove between the abductor hallucis and flexor brevis digitorum. It is much the smaller of the two plantar arteries (Fig. 591).

The external plantar artery runs from the same point as the internal to the inner side of the base of the fifth metatarsal bone. To this point it lies beneath the flexor brevis digitorum and above the accessorius. It then dips deeper, lying on the interossei, and curves inward to end in the communicating artery which pierces the base of the first metatarsal space to anastomose with the dorsalis pedis.

It can be ligated by making an incision at the medial side of the base of the fifth metatarsal bone between the flexor brevis digitorum and the flexor brevis minimi digiti.

Formal ligation of the plantar arteries is not often required. If wounded the bleeding can be stopped by packing the wound, applying pressure, and elevating the foot as high as possible. Care is to be exercised in making incisions in the sole of the foot in the grooves to the inner and outer side of the flexor brevis digitorum for fear of wounding the plantar arteries. The external plantar is, however, not liable to be wounded if the incision is made back toward the tubercle of the os calcis.

Fig. 591.   Plantar arteries and nerves.

Fig. 591. - Plantar arteries and nerves.

The plantar arteries usually escape division in operating subcutaneously on the plantar fascia because the plantar fascia is above the flexor brevis while the arteries are below. It is so difficult to ligate bleeding arteries in the foot that it is usually better to pack the wound with an antiseptic gauze and elevate the limb.