The lateral plantar artery is the larger terminal branch of the posterior tibial artery, passing obliquely across the plantar surface of the foot to the base of the fifth metatarsal before curving medially to form the plantar arch (arcus plantaris) at the level of the metatarsal bases. The plantar arch gives rise to the four plantar metatarsal arteries and anastomoses with the deep plantar artery from the dorsalis pedis.
The lateral plantar artery and its accompanying lateral plantar nerve form the primary neurovascular supply to the lateral forefoot and lesser toes. Peripheral arterial disease affecting the tibial vessels produces forefoot ischaemia with lateral toe necrosis. The plantar arch formed by the lateral plantar artery is clinically important in planning foot and ankle reconstructive procedures. Nerve entrapment of the first branch of the lateral plantar nerve at the heel is the most common cause of inferior heel pain (Baxter nerve entrapment), distinct from plantar fasciitis.
Compression of the first branch of the lateral plantar nerve as it passes between the abductor hallucis and quadratus plantae muscles produces medial plantar heel pain often indistinguishable from plantar fasciitis, without the characteristic morning stiffness pattern, requiring EMG and nerve decompression for diagnosis and treatment.
Peripheral arterial disease or vasospastic conditions affecting the lateral plantar territory produce lateral forefoot and lesser toe ischaemia with absent lateral plantar pulses, requiring vascular assessment and revascularisation in symptomatic cases.
