RETINACULA AROUND THE ANKLE

SUBMITTED BY :- SHOBHIT GARG F 14RETINACULA AROUND THE ANKLE

CONTENTS INTRODUCTION RETINACULA AROUND THE ANKLE EXTENSOR RETINACULASUPERIOR EXTENSOR RETINACULUMINFERIOR EXTENSOR RETINACULUM FLEXOR RETINACULUM PERONEAL RETINACULASUPERIOR PERONEAL RETINACULUMINFERIOR PERONEAL RETINACULUM CLINICAL AND APPLIEDBIBLIOGRAPHY

WHAT IS MEANT BY RETINACULUM ?Deep fascia is modified to form thickened bands called retinaculum.

These thickened bands hold the tendons in position (prevent bowstring of the tendons) and form pulleys within which the tendons slide where they change direction, e.g. wrist and ankle.

RETINACULA AROUND THE ANKLE

EXTENSOR RETINACULA SUPERIOR EXTENSOR RETINACULUM

The retinaculum is attached laterally to the distal end of the anterior border of the fibula and medially to the anterior border of the tibia.Its proximal border is continuous with the fascia cruris, and dense connective tissue connects its distal border to the inferior extensor retinaculum.

Contd. The superior extensor retinaculum binds down the tendons of tibialis anterior, extensor hallucis longus, extensor digitorum longus and fibularis tertius immediately proximal to the anterior aspect of the talocrural joint.

The anterior tibial vessels and deep fibular nerve pass deep to the retinaculum and the superficial fibular nerve passes superficially.

INFERIOR EXTENSOR RETINACULUMThe inferior extensor retinaculum is a Y-shaped band lying anterior to the talocrural joint.The stem of the Y is at the lateral end, where it is attached to the upper surface of the calcaneus.

At the medial end of the loop, two diverging limbs extend medially to complete the Y' shape of the retinaculum.

Contd. The proximal of the two limbs consists of two layers. 1.The deep layer passes deep to the tendons of extensor hallucis longus and tibialis anterior, but superficial to the anterior tibial vessels and deep fibular nerve, to reach the medial malleolus.2.The superficial layer crosses superficial to the tendon of extensor hallucis longus and then adheres firmly to the deep one.

Contd.The distal limb extends downwards and medially and blends with the plantar aponeurosis. It is superficial to the tendons of extensor hallucis longus and tibialis anterior, the dorsalis pedis artery and the terminal branches of the deep fibular nerve.

FLEXOR RETINACULUMThe flexor retinaculum is attached anteriorly to the tip of the medial malleolus, distal to which it is continuous with the deep fascia on the dorsum of the foot From its malleolar attachment it extends posteroinferiorly to the medial process of the calcaneus and the plantar aponeurosis.

Contd.The flexor retinaculum converts grooves on the tibia and calcaneus into canals for the tendons, and bridges over the posterior tibial vessels and tibial nerve.

PERONEAL RETINACULA

The fibular retinacula are fibrous bands that retain the tendons of fibularis longus and brevis in position as these tendons cross the lateral aspect of the ankle region

SUPERIOR PERONEAL RETINACULUM

The superior fibular retinaculum is a short band which extends from the back of the lateral malleolus to the deep transverse fascia of the leg and the lateral surface of the calcaneus. Damage to the retinaculum can lead to instability of the fibular tendons.

INFERIOR PERONEAL RETINACULUM

The inferior fibular retinaculum is continuous in front with the inferior extensor retinaculum, and is attached posteriorly to the lateral surface of the calcaneus. Some of its fibres are fused with the periosteum on the fibular trochlea (peroneal tubercle) of the calcaneus, forming a septum between the tendons of fibularis longus and brevis

CLINICAL AND APPLIED TARSAL TUNNEL SYNDROME This syndrome occurs due to the compression of tibial nerve within the fibro-osseous tunnel under the flexor retinaculum of ankle joint. This is associated with pain and parasthesia in the sole of foot often worse at night.

Contd.

TENOSYNOVITIS AND DISLOCATION OF PERONEUS LONGUS AND BREVIS TENDONS

Tenosynovitis (inflammation of the synovial sheaths) can affect the tendon sheaths of the peroneus longus and brevis muscles as they pass posterior to the lateral malleolus. Treatment consists of immobilization, heat, and physio-therapy. The tendons of peroneus longus and brevis dislocate forward from behind the lateral malleolus if the superior peroneal retinaculum is torn. It usually occurs in older children and is caused by trauma.

BIBLIOGRAPHY GRAYS ANATOMY 40TH EDITION ATLAS OF HUMAN ANATOMY SIXTH EDITION BY FRANK H. NETTER, M.D. SNELLS CLINICAL ANATOMY BY REGIONS 9TH EDITION CUNNINGHAMS MANUAL OF PRACTICAL ANATOMY 15TH EDITION VOL. 1