The plantar metatarsal arteries are four branches arising from the plantar arch (formed from the lateral plantar artery and the deep plantar branch of the dorsalis pedis) that run distally in the intermetatarsal spaces. At the web spaces each divides into two plantar proper digital arteries supplying adjacent toe surfaces. They are reinforced by dorsal metatarsal arteries via perforating branches through the interosseous spaces.
The plantar metatarsal arteries are the primary blood supply to the toes and their patency is essential for toe viability. In diabetic foot disease, atherosclerosis and small vessel disease affecting the plantar metatarsal arteries produce toe ischaemia and digital gangrene even when the larger pedal vessels remain patent. Doppler assessment of individual toe perfusion guides amputation level and wound healing potential. The plantar metatarsal arteries are the vessels targeted in plantar flap design for forefoot reconstruction after partial foot amputation.
Small vessel atherosclerosis of the plantar metatarsal arteries in diabetic foot disease produces digital ischaemia and toe gangrene despite palpable dorsalis pedis and posterior tibial pulses, requiring toe pressure measurement and digital subtraction angiography to assess individual toe perfusion before planned amputation level.
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