Medial Plantar Artery Dominance of the Plantar Arterial Arch: A Unique Anastomosis with Clinical Implications.

Introduction: Forefoot structures are vascularized through the deep plantar arch, an anastomotic network classically described between the deep branch of the lateral plantar artery (dLPA) and the deep plantar artery (DPA). While it supplies the medial aspect of the plantar foot, the medial plantar artery (MPA) is not described as providing a vascular contribution to the deep plantar arterial arch.

Case report: During routine cadaveric dissection of bilateral lower extremities in a 96-year-old Caucasian male, a unique anomaly was noted within the deep plantar arterial arch. The superficial branch of the medial plantar artery (sMPA) was found to course laterally at the level of the first metatarsophalangeal joint and anastomose with the DPA to form the deep plantar arch. No contribution was noted from the LPA. A total of 89 feet from 49 cadavers were subsequently examined, and no other donors exhibited this distinct morphology, resulting in an estimated prevalence of 2.3% of feet.

Conclusion: This case study describes a novel bilateral plantar vascular anomaly and reviews the potential clinical significance of this variant, which should be considered during various reconstructive flap procedures of the foot.