Posterior Tibial Veins

venae tibiales posteriores

The posterior tibial veins are paired venae comitantes accompanying the posterior tibial artery in the deep posterior compartment of the lower leg, receiving tributaries from the plantar veins and the perforating veins of the medial leg. They join with the peroneal veins at the ankle level to form the popliteal vein. The posterior tibial veins are a common site for deep vein thrombosis (calf DVT) and are the distal veins most commonly imaged on lower limb Duplex ultrasound.

Region: Lower Leg

Clinical Relevance

Clinical Notes

Isolated calf vein DVT (posterior tibial, peroneal, or muscular calf veins) carries a lower proximal propagation and pulmonary embolism risk than proximal DVT, but remains clinically significant. Duplex ultrasound compression of the posterior tibial veins at the ankle detects non-compressibility (DVT) in the calf. The management of isolated distal DVT (anticoagulation vs monitoring) is debated, with most guidelines recommending anticoagulation for symptomatic calf DVT and close ultrasound surveillance for incidental or asymptomatic isolated distal DVT.

Pathology

Common Injuries & Conditions

Posterior Tibial Vein DVT as Calf Vein Thrombosis

Thrombus in the posterior tibial veins presents as calf pain and swelling after prolonged immobilisation, long-haul flight, or lower limb surgery; compression Duplex ultrasound at the ankle demonstrates non-compressible posterior tibial veins with absent Doppler flow; anticoagulation for 3 months prevents proximal propagation and treats the symptomatic calf DVT.