This section is from the book "Anatomy Of The Arteries Of The Human Body", by John Hatch Power. Also available from Amazon: Anatomy of the Arteries of the Human Body, with the Descriptive Anatomy of the Heart.
This vessel may be secured in the middle part of its course, either according to Mr. Guthrie's plan, by a long incision made through the gastrocnemii muscles and deep-seated fascia down to the artery; or by the following proceeding:—the patient should lie on the outside of the limb, with the knee flexed, and the ankle extended: an incision is then to be made about four inches long, on the internal margin of the tibia, taking care to avoid the saphena vein. The inner edge of the gastrocnemius muscle is then to be detached from the bone, and the tibial origin of the soleus muscle divided on a director: the strong tibial fascia covering the vessel is now brought into view, and may also be slit up on a director. The artery will then be found at the distance of about an inch, or an inch and a half, from the internal edge of the tibia. The nerve will be seen crossing over towards its outer side, and on either side of it will be found a vein.
This artery may also require to be tied where it is passing behind the internal malleolus, in consequence of a wound to which it is particularly liable amongst ship-carpenters in the use of the adze; or in consequence of a wound of a large vessel in the sole of the foot. For the purpose of securing the vessel in this situation, an incision should be made about four inches long, nearly midway between the internal malleolus and tendo Achillis. This incision will take a curved direction, the concavity looking towards the inner malleolus: in this situation, we have to divide successively on the director the three layers of fascia already described: the artery will then be exposed; on either side of it is a small vein, and behind it, or nearer to the tendo Achillis, is the posterior tibial nerve. The needle should be carried under the artery from behind forwards.
The branches of the posterior tibial artery are the following :—
The Muscular Arteries are abundantly distributed to the heads of the gastrocnemius and soleus muscles, and lower down to the tendons of the flexor muscles, and to the periosteum.
The Nutritious Artery Or Artery Of The Medullary Membrane Of The Tibia is the largest of the kind in the body: it arises from the posterior tibial shortly after its origin from the popliteal, it passes between the flexor muscles of the leg, then grooves the posterior surface of the tibia, and enters the nutritious foramen, running downwards towards the ankle through an oblique canal in the compact tissue of the bone, to be distributed on the medullary membrane.