THE ANTERIOR TIBIAL ARTERY. 823 
between the tendon of the extensor proprius hallucis and the innermost tendon of 
the extensor longus digitorum. 
The anterior tibial nerve is at first well to the outer side of the artery, but 
it soon passes 1n front of the vessel, and it lies upon the artery in its middle third ; 
lower down the nerve is usually found on the outer side again, and at the ankle 
it intervenes between the artery and the innermost tendon of the extensor longus 
digitorum. ; 
Two ven comites, with numerous intercommunications, accompany the artery. 
Obviously the anterior tibial artery is, at least in its upper part, deeply placed ; 
moreover, its lateral muscular boundaries overlap it. In the ereater part of its 
extent it 1s, however, easily accessible from the surface ; and beyond being crossed 
by the nerve and tendon, as already described, is only covered, in addition, by skin, 
fascia, and the anterior annular ligament. 
Branches.—Close to its origin the artery gives off superior fibular and posterior 
tibial recurrent branches ; after it reaches the front of the leg it gives off anterior tibial 
recurrent, muscular, cutaneous, internal malleolar, and external malleolar branches. 
(1) The superior fibular branch is a small vessel which may arise separately from the 
anterior tibial artery, or by a common stem with the posterior tibial recurrent ; occasion- 
ally it springs from the lower end of the popliteal artery, or from the posterior tibial. 
It runs upwards and outwards behind the neck of the fibula and through the fibres of 
the soleus, and it terminates in branches which supply the soleus, the peroneus longus, 
and the skin of the upper and outer part of the leg. It anastomoses with the inferior 
external articular artery. 
(2) The posterior tibial recurrent branch (a. recurrens tibialis posterior), also small, 
and not always present, runs upwards in front of the popliteus muscle to the back of the 
knee-joint. It anastomoses with the inferior articular branches of the popliteal, and 
gives branches to the popliteus muscle and the superior tibio-fibular articulation. 
(5) The anterior tibial recurrent branch (a. recurrens tibialis anterior) arises from the 
anterior tibial artery in front of the interosseous membrane. It runs upwards and inwards, 
between the upper part of the tibialis anticus and the outer tuberosity of the tibia, 
accompanied by the recurrent articular branch of the external popliteal nerve, and after 
supplying the ‘tibialis anticus and the superior tibio-fibular articulation it pierces the 
deep fascia of the leg; it is connected with the anastomoses round the knee-joint formed 
by the articular branches of the popliteal artery, the descending branch of the external 
circumflex ar tery, and the anastomotic artery. 
(4) The muscular branches are distril uted to the museles of the front of the leg, 
and a few small branches also pass backwards to the deep surface of the tibialis posticus 
muscle, 
(5) The cutaneous branches supply the skin of the front of the leg. 
(6) The internal malleolar branch (a. malleolaris anterior medialis) arises from the 
lower part of the anterior tibial artery, and is smaller than its companion on the outer 
side. It runs inwards, beneath the tibialis anticus tendon, ramifies over the internal 
malleolus, anastomosing with branches of the posterior tibial artery, and is distributed to 
the skin and to the ankle-joint. 
(7) The external malleolar branch (a. malleolaris anterior lateralis), more constant 
and larger than the internal, passes outwards beneath the extensor longus digitorum 
and peroneus tertius towards the external malleolus. It anastomoses with the anterior 
peroneal and tarsal arteries, and supplies the ankle-joint and the adjacent articulations. 
Dorsalis Pedis Artery (a. dorsalis pedis)—The dorsal artery of the foot is 
the direct continuation of the anterior tibial; 1t commences opposite the front of 
the ankle-joint, and extends to the posterior extremity of the first imterosseous 
space, where it passes to the plantar aspect of the foot, and, anastomosing with the 
termination of the external plantar artery, completes the plantar arch. 
It is covered superficially by skin and fascia, including the inferior part of the 
anterior annular ligament, and it is crossed, just before it reaches the first inter- 
osseous space, by the innermost tendon of the extensor brevis digitorum. It rests 
upon the anterior ligament of the ankle, the head of the astre avalus, the astragalo- 
navienlar ligament, the dorsum of the navicular b: me, the dorsal naviculo- 
cuneiform and the inter-cuneiform lgaments between the internal and middle 
cuneiform bones. On its outer side is the internal terminal branch of the anterior 
