Extensor Retinacula Revisited
Posted on 17. Jun, 2010 by Anatomy Links in Theory to Practice
In 2007 Abu-Hijleh, M. F. and Harris, P. F. published a paper on the deep fascia of the distal leg, ankle and dorsal foot. Dissecting 14 limbs they examined arrangement, fiber orientation and collagen content.
Among other findings they list the following.
The deep fascia of the distal leg, ankle and dorsal foot forms a continuous sheet containing thickened bands or retinacula. It is anchored to the subcutaneous surface, the tibia and fibula (both malleoli), the tarsal and metatarsal bones.
The Superior Extensor Retinaculum (SER) seems variable in width and thickness. A clearly defined band as generally illustrated is not found. The observed thin bands, possibly representing the SER, run from the tibia to the fibula, crossing the anterior compartment of the distal leg.
Instead of the familiar Y shape the Inferior Extensor Retinaculum (IER) is observed to have an X shape (9 out of 14) or is formed by a central thick node-like band (5 out of 14). Based on dissection findings Abu-Hijleh suggests a physical connection between the IER and the spring ligament.
Several additional bands are consistently found.
The Extensor Digitorum Brevis Retinaculum (EDBR), a band crossing the belly of the muscle connecting with the IER and fascia over the abductor digiti minimi.
The Proximal Extensor Hallucis Retinaculum (PEHR), a band crossing the distal tendons of the extensor hallucis longus and brevis and the distal tibialis anterior attachment (specifics are not given) at the tarsal/metatarsal level. This band connects with the abductor hallucis (its fascia) and the (dorsal) interosseous fascia of the foot.
The Distal Extensor Hallucis Retinaculum (DEHR), a band crossing the distal tendons of the extensor hallucis longus and brevis at the distal metatarsal level. This band also connects with the abductor hallucis (its fascia), the (dorsal) interosseous fascia of the foot and the DLPF.
The Disto-Lateral Pedal Fascia (DLPF), a band crossing the distal tendons of the extensor digitorum longus and brevis at a distal metatarsal level. This band connects with the abductor digiti minimi (its fascia), the (dorsal) interosseous fascia of the foot and the DEHR.
Malleolar Fascia (MF), oblique transverse bands on the tibial and fibular sides, crossing over the malleoli. Both bands connect with the SER.
In regard to collagen fiber disposition, using polarized light a “crisscrossing or woven mesh pattern” is observed. This pattern is observed in all specimens from the distal lower leg to the dorsum of the foot. Histological sections show collagen fibers with elongated nuclei and confirm the “crisscrossing or woven mesh pattern”.
From Theory to Practice
Based on Abu-Hijleh’s research we can opt to consider the individual thickened bands (retinacula) and fiber orientation when treating the deep fascia of the distal lower leg, ankle, dorsum of the foot and its related organs.
Because of the PEHR and DEHR, abductor hallucis, extensor hallucis longus connections we can, for example, consider the abductor hallucis when addressing a flexor hallucis related problem. And the “crisscrossing or woven mesh pattern” might require us to “aim” our therapy and exercises in more than a single direction.
For first hand details please read:
Abu-Hijleh MF, Harris PF. Deep fascia on the dorsum of the ankle and foot: extensor retinacula revisited. Clin Anat. 2007 Mar;20(2):186-95.
Physical Holism
Posted on 05. Jun, 2010 by Anatomy Links in Theory to Practice
Instead of providing a segmented view, Anatomy Links promotes the body as a whole.
Although segmentation and dissection certainly have their purpose, I believe our often applied sectional approach should take a backseat during our clients’ assessment, treatment and training.
We have to realize that all systems and all their individual parts cannot exist on their own. In other words, our muscles, deep fasciae, bones, nerves, vessels, joint capsules, skin and other organs only endure and function because they inter-connect, because they relate and influence one another. It is because of this that isolated or disconnected parts wither and die.
Without listing every possible scenario and mentioning particulars on inter-organ connections ….
It is important to realize that muscle connects with skin. Because it does, muscle pain, dysfunction or injury projects on connecting skin and vice versa. Consequently, treating connecting skin has a positive influence over muscle and vice versa.
It is important to realize deep fascia connects with muscle. Because it does deep fascia pain, dysfunction or injury projects on connecting muscle and vice versa. Consequently, treating connecting deep fascia has a positive influence over muscle and vice versa.
It is important to realize that veins connect with joint capsule. Because they do vein pain, dysfunction or injury projects on connecting joint capsule and vice versa. Consequently, treating connecting veins has a positive influence over joint capsule and vice versa.
Because of physical inter-organ connections we can approach pain, dysfunction or injury from many different angles. After all, we can treat and exercise all connecting organs to solve dysfunction, alleviate pain and promote recovery.
So, after vigorously studying the nervous, circulatory, musculoskeletal and visceral systems and all their individual parts it might be time to put them all together and see the physical human body for what it is; a singular entity, ONE.