Deep fascia on the dorsum of the ankle and foot: Extensor retinacula revisited

Abstract

This study revisits the anatomy of the deep fascia over the distal leg, ankle, and dorsum of the foot. The arrangement of the deep fascia in these regions was recorded in 14 lower limbs of adult cadavers using photographs and drawings. The fascial layer from all three sites was subsequently removed in toto, and serial thickness measurements were made along its entire length. In addition, fiber disposition was studied under polarized light, and sections were stained to demonstrate collagen. The arrangement of deep fascia is complex. A common and novel finding at all levels is a crisscross, lattice-like arrangement of fibers. There was little evidence of the clearly defined sturdy band of the superior extensor retinaculum (SER) or of the Y-shaped inferior retinaculum (IER) commonly illustrated in topographical anatomy texts. The SER is a complex area with several thickenings commencing about 3 cm proximal to the tip of the lateral malleolus and gradually increasing to reach a maximum of 270 microm about 5 cm above the malleolus, then gradually returning to original thickness, about 9 cm above the malleolus. Fibers crossing diagonally to each other are a feature of the region. The IER characteristically has two forms: either a cross-shaped band (9 specimens) or a thickened "node" with small extensions radiating toward the malleoli (5 specimens), located about 1-2 cm distal to the lateral malleolus and centred over the common tendon of extensor digitorum where it has maximum thickness (430 microm). The deep fascia is thickened and firmly attached over both malleoli and to the tarsals and metatarsals along both borders of the foot. In general, the deep fascial structures were thicker in males than those in females.

Skin, fascias, and scars: symptoms and systemic connections

“…The gluteal fascia departs from the iliac crest and, through the sacrum and the coccygeal bone, runs to the femoral fascia; the latter will then become the tibial fascia, involving the tibia and fibula, finally enclosing the whole foot 69–72. The gluteus maximus is part of the thoracolumbar fascia, and the fascia of the lower limbs is its logical extension 40.…”

Retinacular Disorders of the Ankle and Foot

“…The small triangular fibrocartilaginous ridge can be depicted as a low-signal-intensity meniscus-like structure close to its origin on the tip of the lateral malleolus. 37 Traumatic injury to the superior peroneal retinaculum is well documented. This lesion is produced by sudden dorsiflexion of the foot.…”

Snapping of the Extensor Digitorum Longus Due to Attenuated Inferior Extensor Retinaculum: Case Report

“…Probably the role of the IER on this location is limiting side-to-side movement of the EDL rather than preventing bowstringing. Abu-Hijleh et al 1 confirmed that robust loops of the IER exist for the common tendon of the EDL and for the tendon of the EHL but not for the tibialis anterior based on 14 lower limbs of cadavers. The IER was represented by a central thick nodelike (knot) overlying the EDL immediately before it divided into its digital components in their study.…”