International Journal of Anatomy and Research, Int J Anat Res 2016, Vol 4(2):2392-96. ISSN 2321-4287 Original Research Article DOI: http://dx.doi.org/10.16965/ijar.2016.228 A STUDY OF PLANTAR ARTERIAL ARCH WITH ITS SURGICAL PERSPECTIVE Anupama K *1, Saraswathi G 2, Shailaja Shetty 3. *1 Assistant professor, Department of Anatomy, M S Ramaiah Medical College. Bangalore, Karnataka, India. 2 Retired Professor, Department of Anatomy, J S S Medical College, JSS University, Mysore, Karnataka, India. 3 Professor and Head, Department of Anatomy, M S Ramaiah Medical College. Bangalore, Karnataka, India. ABSTRACT Introduction: In the present day scenario the advances in the field of plastic, reconstructive and microvascular surgeries of the foot has necessitated a thorough knowledge of variations in the formation and branching pattern of plantar arterial arch. The blood supply of the sole is rich and is derived from the branches of the plantar arterial arch formed by variable contributions of dorsalis pedis artery, lateral plantar artery and medial plantar artery. Materials and Methods: 50 feet of the formalin fixed adult human cadavers were dissected and studied, in the Department of anatomy, JSS Medical College, Mysore. Results: The formation of plantar arterial arch and the origin of plantar metatarsal arteries were noted. The plantar arterial arch was classified into six types based on the origin of plantar metatarsal arteries. Type A-10%, Type B- 4%, Type C- 26%, Type D- 36%, Type E- 20%, Type F- 4%. It was also classified into 3 types based on the contribution of the formative arteries. Type I – 40%, Type II – 36% and Type III – 24%. Conclusion: The present study was undertaken due to its clinical importance in the field of reconstructive surgery, microvascular surgery and autograft transplantation. KEY WORDS: Plantar arterial arch, Plantar metatarsal arteries, Reconstructive surgery; Microvascular surgery. Address for Correspondence: Dr Anupama K, Assistant Professor, Department of Anatomy, MSRIT Post, M S Ramaiah Medical College, Bangalore- 560054, India. Phone No: 9449249001 E-Mail: [email protected] Access this Article online Quick Response code Web site: International Journal of Anatomy and Research ISSN 2321-4287 www.ijmhr.org/ijar.htm Received: 05 May 2016 Accepted: 16 May 2016 Peer Review: 05 May 2016 Published (O): 31 May 2016 DOI: 10.16965/ijar.2016.228 Revised: None Published (P): 31 May 2016 INTRODUCTION The architecture of the skeletal and fibro derived from three source deep plantar branchof muscular components of the foot is very nicely Dorsalis pedis artery (DPA), Lateral plantar ar- designed to support its function. The blood tery (LPA) and Medial plantar artery (MPA). The supply maintains the structural integrity of the plantar arterial arch (PA) is formed by the structures [1]. The arteries of the sole are variable contribution of the Lateral plantar Int J Anat Res 2016, 4(2):2392-96. ISSN 2321-4287 2392 Anupama K, Saraswathi G, Shailaja Shetty. A STUDY OF PLANTAR ARTERIAL ARCH WITH ITS SURGICAL PERSPECTIVE. artery and the deep branch of Dorsalis pedis plantar metatarsal arteries take origin from lat- artery [2]. The plantar arch gives off three eral plantar artery 3. This study was undertaken perforating and four plantar metatarsal branches because of its clinical importance in reconstruc- and an additional lateral digital branch to the tive surgery, vascular surgery, and autograft fifth toe which is known as Fibular Plantar Mar- transplantation. ginal artery (FPMA) [3,4]. MATERIALS AND METHODS Variations in the branching pattern of plantar arterial arch have been described and are fairly 50 feet (25 right and 25 left) from 25 embalmed common. This is due to variable contributions adult cadavers (21 male and 4 female, 35-70 of dorsalis pedis artery and lateral plantar years of age) were dissected and studied in the artery for the origins of plantar metatarsal Department of anatomy, JSS Medical College, arteries. Mysore. The structures of the foot were In the present study the variations in the dissected carefully layer by layer. The oblique formation and branching pattern of the plantar head of adductor hallucis was dissected to arterial arch was noted and it was classified visualize the full course of lateral plantar artery based on the origin of plantar metatarsal and plantar arterial arch. The plantar arteries as described by Saraffian: metatarsal arteries were traced and its origin was noted. The presence of fibular plantar Type A: The arch was formed only by the deep marginal artery and its origin was noted. plantar branch of dorsalis pedis artery and supplies all the plantar metatarsal arteries 1 to The contribution of dorsalis pedis artery and 4 and the fibular plantar marginal artery. lateral plantar artery in the origins of plantar metatarsal arteries and fibular plantar marginal Type B: The point of union was located between artery was noted to be variable. The length of the 4th plantar metatarsal artery and the fibular the plantar arterial arch was measured from the plantar marginal artery. The deep plantar branch point proximal to first metatarsal artery to the of dorsalis pedis artery supplies the plantar point distal to the last metatarsal artery. The metatarsal arteries 1 to 4. length and the diameter were measured using Type C: The point of union was located between a vernier caliper. Predominant artery contribut- rd th the 3 and 4 plantar metatarsal arteries. The ing to the formation of plantar arch was deep plantar branch of dorsalis pedis artery determined by measuring the diameter of the provides the plantar metatarsal arteries 1 to 3. arch at each commissure between the plantar The lateral plantar artery provides fibular metatarsal arteries in the entire course of the th plantar marginal artery and 4 plantar plantar arch. The commissure with the smallest metatarsal artery. diameter determined the point of anastomosis Type D: The point of union was located between between the deep branch of dorsalis pedis the 2nd and 3rd plantar metatarsal arteries. The artery and lateral plantar artery. Thus the origin deep plantar branch of dorsalis pedis artery of plantar metatarsal arteries was also provides the plantar metatarsal arteries 1 and determined. 2. The lateral plantar artery supplies fibular The plantar arterial arch and its branches were th rd plantar marginal artery, 4 and 3 plantar then coated with acetone and quickfix solution, metatarsal arteries. painted using synthetic enamel asian paints and Type E: The point of union was located between photographed. The plantar arterial arch was then the 1st and 2nd plantar metatarsal arteries. The classified as described above. deep plantar branch of dorsalis pedis artery supplies only first plantar metatarsal artery. The OBSERVATIONS AND RESULTS lateral plantar artery supplies fibular plantar marginal artery, 4th and 3rd and 2nd plantar The plantar arterial arch was present in all 50 metatarsal arteries. specimens. The classification of plantar arterial Type F: The plantar arterial arch was formed arch based on the contributions is shown in the entirely by the lateral plantar artery and all the table below. Int J Anat Res 2016, 4(2):2392-96. ISSN 2321-4287 2393 Anupama K, Saraswathi G, Shailaja Shetty. A STUDY OF PLANTAR ARTERIAL ARCH WITH ITS SURGICAL PERSPECTIVE. Origin of Plantar Origin of Plantar Type of plantar metatarsal arteries metatarsal No of specimens Percentage arterial arch from DPA arteries from LPA Right Left Total 1 to 4 Plantar Table 1: Typing based on the Type A metatarsal arteries+ _ 2 3 5 10% origin of plantar metatarsal FPMA. arteries in the present study. 1 to 4 Plantar (DPA= Dorsalis pedis artery, Type B FPMA 1 1 2 4% LPA= Lateral plantar artery, metatarsal arteries FPMA= Fibular plantar marginal 4th Plantar 1 to 3 Plantar Type C metatarsal arteries 4 9 13 26% artery). metatarsal arteries + FPMA 3 & 4 Plantar 1 & 2 Plantar Type D metatarsal arteries 9 9 18 36% metatarsal arteries + FPMA 2 to 4 Plantar 1st Plantar Type E metatarsal arteries 8 2 10 20% metatarsal artery + FPMA All plantar Type F _ metatarsal arteries 1 1 2 4% + FPMA Table 2: Showing measurements of Plantar arterial arch Fig. 2: Showing the Type B plantar arterial arch. using a vernier caliper. Mean length Mean diameter Right Left Right Left 4.62 4.74 0.41 0.39 Based on the amount of contribution from dorsalis pedis and lateral plantar arteries for the formation of plantar arterial arch it can be divided into three types. Type I: Predominant contribution from Dorsalis pedis artery which was seen in 40% of the specimens. Type II: Predominant contribution from Lateral plantar artery which was seen in 36% of the specimens. Type III (Balanced type): Equal contributions of Fig. 3: Showing the Type C plantar arterial arch. both Dorsalis pedis and lateral plantar arteries which was seen in 24% of the specimens. Fig. 1: Showing Type A plantar arterial arch. Int J Anat Res 2016, 4(2):2392-96. ISSN 2321-4287 2394 Anupama K, Saraswathi G, Shailaja Shetty. A STUDY OF PLANTAR ARTERIAL ARCH WITH ITS SURGICAL PERSPECTIVE. Fig. 4: Showing the Type D plantar Fig. 5: Showing the Type E plantar Fig. 6: Showing the Type E arterial arch. arterial arch. plantar arterial arch. In all the above figures the black arrow represents the junction between dorsalis pedis and lateral plantar arteries. DISCUSSION involves the pedal arteries. In cases where ei- Table 3: Comparison of incidence of different types of ther dorsalis pedis artery or lateral plantar ar- plantar arterial arch of our study with the other studies. tery is predominantly contributing to origin of all plantar metatarsal arteries; if it is involved Type of plantar Kalicharan A et al. Manno Adachi Present study arterial arch (40 feet) (66 feet) (130 feet) (50 feet) in injury or occlusion then the amount of dam- age resulting due to it is extensive.