{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T14:13:28Z","timestamp":1780496008006,"version":"3.54.1"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Manipal Academy of Higher Education, Manipal"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Radiol Anat"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>The posterior tibial artery (PTA) branching within the tarsal tunnel is subject to significant anatomical variation, which can complicate surgical procedures such as tarsal tunnel decompression, flap harvesting, and medial ankle fixation. This study aimed to quantify the morphometry of the PTA bifurcation relative to the Dellon\u2013McKinnon malleolar-calcaneal line (DML) in order to define vascular \u201csafe zones.\u201d<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Twenty-five formalin-fixed adult cadaveric limbs were dissected. The bifurcation of the PTA into the medial and lateral plantar arteries was identified. Measurements were taken in cm with the help of digital vernier calipers and angle with the help of goniometer. The following measurements included the bifurcation level relative to the DML (superior to, at, or inferior to), the distance from the DML, the bifurcation angle, and total foot length. The SSPS software was used for data analysis. Descriptive statistics were conducted for all the parameters. Correlation analysis was done to check for any association between foot length and artery branching length and artery branching angle. Spearman\u2019s Rank Correlation was done to check for the correlation between foot length and the medial and lateral plantar artery lengths. To establish whether there is any difference in foot length, angle of bifurcation, and distance of bifurcation from DML between limbs whose PTA divides superior to and inferior to the DML we have used an independent samples t- test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The PTA bifurcated superior to the DML in 52%, at the level of the DML in 28%, and inferior to the DML in 20% of specimens. The mean bifurcation angle was 22.60\u00b0. A strong positive correlation was found between foot length and angle of division below the DML line, but it was not significant. (r\u2009=\u20090.516,\n                      <jats:italic>p<\/jats:italic>\n                      value-0.374). Rare variations, including arterial trifurcation and early anastomosis, were documented.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The majority of PTA bifurcations occur proximal to or at the level of the DML. This high prevalence of proximal branching suggests that surgical incisions for medial ankle exposure are statistically safer when positioned at or distal to the DML to avoid iatrogenic arterial trauma.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00276-026-03914-x","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T13:14:33Z","timestamp":1780492473000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Terminal branching pattern of posterior tibial artery in the tarsal tunnel: a cadaveric study with its clinical importance in medial ankle surgeries"],"prefix":"10.1007","volume":"48","author":[{"given":"Nashra","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9232-0946","authenticated-orcid":false,"given":"Chandni","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul","family":"Shekhar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suriti","family":"Pathak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivam","family":"Thaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayank","family":"Jha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simki","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7687-5447","authenticated-orcid":false,"given":"Souhardya","family":"Das","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benzeer","family":"Idli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,3]]},"reference":[{"issue":"3","key":"3914_CR1","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1053\/j.jfas.2019.08.030","volume":"59","author":"C Blanton","year":"2020","unstructured":"Blanton C, Kercado M, Nordquist T, Masadeh S, Rodriguez P, Rodriguez-Collazo E (2020) Medial plantar artery common origin to determine incision placement for the fasciocutaneous flap: a cadaveric study. J Foot Ankle Surg 59(3):462\u2013464. https:\/\/doi.org\/10.1053\/j.jfas.2019.08.030","journal-title":"J Foot Ankle Surg"},{"issue":"10","key":"3914_CR2","doi-asserted-by":"publisher","first-page":"2512","DOI":"10.1016\/j.bjps.2021.03.054","volume":"74","author":"ZQ Cang","year":"2021","unstructured":"Cang ZQ, Xu Y, Wang M, Xu MN, Yuan SM (2021) Anterior tibial artery injury is not the contraindication of medial plantar flap: digital subtraction angiography evidence and clinical application. J Plast Reconstr Aesthet Surg 74(10):2512\u20132518. https:\/\/doi.org\/10.1016\/j.bjps.2021.03.054","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"6","key":"3914_CR3","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1001\/archneur.1984.04210080053013","volume":"41","author":"AL Dellon","year":"1984","unstructured":"Dellon AL, Mackinnon SE (1984) Tibial nerve branching in the tarsal tunnel. Arch Neurol 41(6):645\u2013646 (PMID: 6721738)","journal-title":"Arch Neurol"},{"issue":"2","key":"3914_CR4","first-page":"311","volume":"28","author":"LK Dhar","year":"2019","unstructured":"Dhar LK, Talukder A, Kaiser A, Razia S, Jahan I, Islam MS (2019) Posterior tibial artery perforator based propeller flap for lower leg and ankle defect coverage: a prospective observational study. Mymensingh Med J 28(2):311\u2013316 (PMID: 31086144)","journal-title":"Mymensingh Med J"},{"issue":"3","key":"3914_CR5","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1016\/j.bjps.2019.10.019","volume":"73","author":"D Guillier","year":"2020","unstructured":"Guillier D, Cherubino M, Oranges CM, Giordano S, Raffoul W, di Summa PG (2020) Systematic reappraisal of the reverse-flow medial plantar flap: from vascular anatomical concepts to surgical applications. J Plast Reconstr Aesthet Surg 73(3):421\u2013433. https:\/\/doi.org\/10.1016\/j.bjps.2019.10.019","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"2","key":"3914_CR6","first-page":"167","volume":"38","author":"D G\u00fclabi","year":"2018","unstructured":"G\u00fclabi D, \u00d6zkaya U, Ozan M, Kabuk\u00e7uo\u011flu YS (2018) Posterior tibial artery perforators\u2019 relationship with superficial nerves and veins in the lower leg: a cadaveric study. Microsurgery 38(2):167\u2013173 (PMID: 29664183)","journal-title":"Microsurgery"},{"issue":"3","key":"3914_CR7","doi-asserted-by":"publisher","first-page":"92","DOI":"10.5152\/j.aott.2023.22158","volume":"57","author":"B Karip","year":"2023","unstructured":"Karip B, Erta\u015f A, Balc\u0131o\u011flu HA (2023) Anatomical study of the distal course of the posterior tibial artery: a cadaver study. Acta Orthop Traumatol Turc 57(3):92\u201398. https:\/\/doi.org\/10.5152\/j.aott.2023.22158","journal-title":"Acta Orthop Traumatol Turc"},{"issue":"1","key":"3914_CR8","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1097\/SAP.0000000000003577","volume":"91","author":"S Karmakar","year":"2023","unstructured":"Karmakar S, Singla P (2023) An unreported variation of origin of posterior tibial artery encountered during free fibula flap harvest. Ann Plast Surg 91(1):101\u2013103. https:\/\/doi.org\/10.1097\/SAP.0000000000003577","journal-title":"Ann Plast Surg"},{"key":"3914_CR9","doi-asserted-by":"crossref","unstructured":"Koshi R (2024) Cunningham\u2019s manual of practical anatomy. General anatomy, upper and lower limbs.17th Ed. United states, oxford university press, new york, pp 274\u2013276.","DOI":"10.1093\/med\/9780198923343.001.0001"},{"issue":"1","key":"3914_CR10","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1097\/00006534-199701000-00036","volume":"99","author":"I Koshima","year":"1997","unstructured":"Koshima I, Soeda S (1997) Free posterior tibial perforator flap: anatomy and a report of six cases. Plast Reconstr Surg 99(1):90\u201396 (PMID: 9393868)","journal-title":"Plast Reconstr Surg"},{"issue":"6","key":"3914_CR11","doi-asserted-by":"publisher","first-page":"499","DOI":"10.2106\/JBJS.15.00787","volume":"98","author":"MC Manske","year":"2016","unstructured":"Manske MC, McKeon KE, McCormick JJ, Johnson JE, Klein SE (2016) Arterial anatomy of the posterior tibial nerve in the tarsal tunnel. J Bone Joint Surg Am 98(6):499\u2013504 (PMID: 26984918)","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"3914_CR12","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1007\/s0027602303115w","volume":"45","author":"B Marchese","year":"2023","unstructured":"Marchese B, McDonald A, McGowan H (2023) The bifurcation and topography of the posterior tibial artery within the tarsal tunnel. Surg Radiol Anat 45(5):611\u2013622. https:\/\/doi.org\/10.1007\/s0027602303115w","journal-title":"Surg Radiol Anat"},{"issue":"6","key":"3914_CR13","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1097\/00006534-199206000-00018","volume":"89","author":"AC Masquelet","year":"1992","unstructured":"Masquelet AC, Romana MC, Wolf G (1992) Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg. Plast Reconstr Surg 89(6):1115\u20131121. https:\/\/doi.org\/10.1097\/00006534-199206000-00018. (PMID: 1584872)","journal-title":"Plast Reconstr Surg"},{"issue":"12","key":"3914_CR14","doi-asserted-by":"publisher","first-page":"1473","DOI":"10.1007\/s00276-019-02262-3","volume":"41","author":"\u0141 Olewnik","year":"2019","unstructured":"Olewnik \u0141, \u0141ab\u0119towicz P, Podg\u00f3rski M, Polguj M, Ruzik K, Topol M (2019) Variations in terminal branches of the popliteal artery: cadaveric study. Surg Radiol Anat 41(12):1473\u20131482. https:\/\/doi.org\/10.1007\/s00276-019-02262-3. (Epub 2019 May 27. PMID: 31134299; PMCID: PMC6853856.)","journal-title":"Surg Radiol Anat"},{"issue":"2","key":"3914_CR15","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/s00276-018-2124-z","volume":"41","author":"S Simone","year":"2019","unstructured":"Simone S, Zwierzina M, Starke VZ, Moriggl B, Montesi F, Konschake M (2019) Clinical-anatomic mapping of the tarsal tunnel with regard to Baxter\u2019s neuropathy in recalcitrant heel pain syndrome: part I. Surg Radiol Anat 41(2):29\u201341. https:\/\/doi.org\/10.1007\/s00276-018-2124-z","journal-title":"Surg Radiol Anat"},{"issue":"1","key":"3914_CR16","first-page":"76","volume":"57","author":"Z Tosun","year":"2006","unstructured":"Tosun Z, Yildiz Y, Acar MA, Yildiz D (2006) Examination of the skin perforators of the posterior tibial artery on the medial surface of the lower leg: a cadaver study. Ann Plast Surg 57(1):76\u201380 (PMID: 16641734)","journal-title":"Ann Plast Surg"},{"issue":"1","key":"3914_CR17","doi-asserted-by":"publisher","DOI":"10.1038\/srep46351","volume":"7","author":"Y Yang","year":"2017","unstructured":"Yang Y, Du ML, Fu YS, Liu W, Xu Q, Chen X et al (2017) Fine dissection of the tarsal tunnel in 60 cases. Sci Rep 7(1):46351","journal-title":"Sci Rep"},{"issue":"1","key":"3914_CR18","doi-asserted-by":"publisher","first-page":"64","DOI":"10.11152\/mu.2013.2066.181.mzh","volume":"18","author":"M Zheng","year":"2016","unstructured":"Zheng M, Chen C, Qiu Q, Wu C (2016) Ultrasound in diagnosis of anatomical variation of anterior and posterior tibial arteries. Med Ultrason 18(1):64\u201369. https:\/\/doi.org\/10.11152\/mu.2013.2066.181.mzh. (PMID: 26962556)","journal-title":"Med Ultrason"}],"container-title":["Surgical and Radiologic Anatomy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00276-026-03914-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00276-026-03914-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00276-026-03914-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T13:14:36Z","timestamp":1780492476000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00276-026-03914-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,3]]},"references-count":18,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3914"],"URL":"https:\/\/doi.org\/10.1007\/s00276-026-03914-x","relation":{},"ISSN":["1279-8517"],"issn-type":[{"value":"1279-8517","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,3]]},"assertion":[{"value":"23 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 May 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 June 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Institutional ethical clearance was taken from the Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee before starting the study. (IEC no. 695\u20132025).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"147"}}