Aneurysms of tibial arteries are extremely rare. Here we report a case of a true posterior tibial artery aneurysm in a young patient without any associated pathology and discuss surgical and endovascular treatment. A young Caucasian male was admitted to our department for painful and pulsatile swelling of the right calf. Colour Doppler ultrasound scan visualised an aneurysmal dilation of the posterior tibial artery. The patient had no trauma to the area and denied other history of vascular disease. Angio-CT and angio-magnetic resonance imaging showed a larger aneurysm compared to ultrasound scan. We performed an embolisation of the aneurysm because of the risk of rupture, as distal collateral circulation ensured foot vascularisation. Endovascular treatment of aneurysms of small arteries seems to be a safe therapeutic and non-invasive choice, particularly in young patients in whom the presence of collaterals guarantees distal vascularisation.