Anatomical variations of the deep plantar arterial arch: surgical implications for partial foot amputations and soft tissue reconstruction.

Abstract

Background: The forefoot receives its primary blood supply through the deep plantar arterial arch, typically formed by an anastomosis between the deep branch of the lateral plantar artery and the deep plantar artery. Accurate identification and localization of the deep plantar arch are critical during flap procedures and transmetatarsal amputations to minimize the risk of vascular compromise.

Purpose: To assess the anatomical variability, dominance patterns, and location of the deep plantar arch to inform surgical planning and reduce intraoperative vascular complications.

Study design: This was a descriptive anatomical study conducted through cadaveric dissection.

Methods: Eighty-nine feet from 45 formalin-embalmed cadavers were dissected, with associated arteries traced from their origins and external diameters measured to determine arterial dominance. Distances from key anatomic landmarks were recorded to identify the arch's position within the foot.

Results: The deep plantar arch was present in all specimens. Lateral plantar artery dominance and deep plantar artery dominance were each observed in 42.70%, while co-dominance occurred in 12.36%, and medial plantar artery dominance in 2.25%. On average, the arch was located 58.48% of the distance from the calcaneal tuberosity to the distal phalanx. Medial deviation of the arch was found to be influenced by biological sex and the type of vascular dominance.

Conclusion: The deep plantar arch demonstrates variability in both its dominance patterns and anatomic position. These findings underscore the importance of preoperative vascular assessment to optimize surgical outcomes and reduce the risk of ischemic complications during forefoot procedures.