The medial plantar artery is the smaller terminal branch of the posterior tibial artery, arising at the level of the sustentaculum tali after passing through the tarsal tunnel. It runs forward beneath the abductor hallucis, divides into superficial and deep branches, and supplies the medial sole, the abductor hallucis, flexor digitorum brevis, and flexor hallucis brevis, before contributing to the hallux digital artery.
The medial plantar artery travels through the tarsal tunnel alongside the medial plantar nerve, and compression of both at this level produces combined motor and sensory symptoms on the medial plantar surface, known as tarsal tunnel syndrome. The superficial branch anastomoses with the plantar digital arteries. In microvascular surgery, the medial plantar artery is the pedicle for the medial plantar island flap used in heel pad reconstruction.
Compression of the medial plantar neurovascular bundle within the tarsal tunnel by a space-occupying lesion, hindfoot valgus, or scar tissue produces plantar heel and arch pain with Tinel sign posterior to the medial malleolus, treated with orthotic correction or surgical decompression.
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