Posterior Tibial Vein

vena tibialis posterior

The posterior tibial veins are paired deep veins accompanying the posterior tibial artery in the deep posterior compartment of the leg, running between the flexor digitorum longus and flexor hallucis longus muscles. They join the anterior tibial veins at the lower border of the popliteus to form the popliteal vein. The posterior tibial veins receive tributaries from the peroneal veins and the soleal sinusoids, the primary site of lower limb deep vein thrombosis formation.

Region: Lower Leg

Clinical Relevance

Clinical Notes

The posterior tibial veins and the soleal sinusoids they drain are the most common sites of deep vein thrombosis in the lower limb. Calf DVT detected by venous duplex ultrasound in the posterior tibial or peroneal veins has significant implications for anticoagulation decisions, as isolated calf DVT has a lower risk of pulmonary embolism than femoral or iliac DVT but a higher risk of proximal propagation. The posterior tibial vein is the target of direct catheter access for endovascular intervention in tibiopedal approaches for below-the-knee peripheral arterial disease.

Pathology

Common Injuries & Conditions

Calf Deep Vein Thrombosis

Thrombus formation within the posterior tibial and peroneal veins and their soleal tributaries produces calf pain, swelling, and a positive Homan sign, diagnosed by compression duplex ultrasound and managed with anticoagulation for at least 3 months with surveillance for proximal propagation.