Monday, October 11, 2010

Ankle Stability – The Retinaculum Part 1

Usually when we think about ankle problems, we think about sprained ankles or a strained muscle, not something called a retinaculum. Yet these fascial structures play a significant role in a wide variety of chronic ankle problems.
So what is a retinaculum? From one perspective a retinaculum is a band of thick deep fascia that holds the long tendons of your ankle (those that cross the ankle) in place. Retinaculum also acts as a pulley system increasing mechanical advantage.

From the second perspective retinaculum are a major source of neurological receptors involved in balance and proprioception. Essentially retinacula have been hypothesized as key structures in spatial control for foot and ankle movements.

The following section is an overview of specific retinacula and what structures pass underneath them. As you look over the individual sections of the retinaculum also think of these areas as part of one large fascial interconnecting unit.

Retinacula do not exist as they are illustrated
Last year at the second international fascia conference in Amsterdam it became very clear to me that retinacula do not exist as they are illustrated in textbooks. There is a lot of interconnecting fascia that has to be removed before retinaculum look the way they are presented in text books. Research is now showing that these fascial connections (which are removed by dissection) are very important for both force transmission and neurological function.

Retinaculum Anatomy:
Front (Anterior) Ankle Retinaculum
Extensor retinaculum (2 parts)
o This structure holds in place tendons from the following muscles; tibialis anterior, extensor digitorum longus, extensor hallucis longus, and peroneus tertius.
o The deep peroneal nerve also passes under the retinaculum.
o The inferor retinaculum is shaped like a Y (once the entire surrounding fascia is removed) and has a lower and upper portion. The Y shape has the function of preventing “Bowstringing” of the tendons during ankle motion.
Pain/Symptom pattern: If there is a restriction in an extensor retinaculum, (front of the ankle) you may experience the following symptoms:
  • Localized pain or restriction on the front of ankle when running or walking. It is a very common symptom that I see with runners.
  • Tension can also alter the muscle firing patterns in the lower extremity. This can create a host of injuries and result in a substantial decrease in athletic performance
In part two of Ankle Stability – The Retinaculum, we will cover the lateral and medial retinaculum.

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