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Retinacula of the Foot and Ankle: MRI with Anatomic Correlation in Cadavers

¹ Department of Radiology, Veterans Affairs Medical Center, University of California, San Diego, 3350 La Jolla Village Dr., San Diego, CA 92161.
² Present address: Nevada Imaging Centers-Siena, Henderson, NV.
³ Present address: Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Superior extensor retinaculum in cadaver. Axial T1-weighted image (A) and corresponding photograph of gross section (B) 1.5 cm above tibiotalar joint show medial and lateral attachments of superior extensor retinaculum at anterior crest of tibia (black arrow) and lateral malleolus (white arrow).

View larger version (126K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Superior extensor retinaculum in cadaver. Axial T1-weighted image (A) and corresponding photograph of gross section (B) 1.5 cm above tibiotalar joint show medial and lateral attachments of superior extensor retinaculum at anterior crest of tibia (black arrow) and lateral malleolus (white arrow).

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Superior extensor retinaculum in cadaver. Axial T1-weighted image shows separate tunnel (arrows) formed by dissociation of superior extensor retinacular fibers for anterior tibialis tendon.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Superior peroneal retinaculum in cadaver. Axial T1-weighted image (A) and corresponding photograph of gross section (B) show superior peroneal retinaculum attaching laterally to lateral malleolus and medially in continuity with superficial (white arrows) and deep (black arrows) aponeuroses of posterior compartment of lower portion of leg.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Superior peroneal retinaculum in cadaver. Axial T1-weighted image (A) and corresponding photograph of gross section (B) show superior peroneal retinaculum attaching laterally to lateral malleolus and medially in continuity with superficial (white arrows) and deep (black arrows) aponeuroses of posterior compartment of lower portion of leg.

View larger version (99K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —Superior peroneal retinaculum in cadaver. Axial T1-weighted image (C) and corresponding photograph of gross section (D) show superior peroneal retinaculum (thin arrows) attaching to lateral wall of calcaneus just posterior to attachment site of calcaneofibular ligament (thick arrow).

View larger version (86K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2D —Superior peroneal retinaculum in cadaver. Axial T1-weighted image (C) and corresponding photograph of gross section (D) show superior peroneal retinaculum (thin arrows) attaching to lateral wall of calcaneus just posterior to attachment site of calcaneofibular ligament (thick arrow).

View larger version (94K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Inferior peroneal retinaculum in cadaver. Axial T1-weighted image (A) and corresponding photograph of gross section (B) at level of trochlear process (thick arrow) show inferior peroneal retinaculum (thin arrows) attaching to retrotrochlear eminence and covering peroneus tendons.

View larger version (85K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Inferior peroneal retinaculum in cadaver. Axial T1-weighted image (A) and corresponding photograph of gross section (B) at level of trochlear process (thick arrow) show inferior peroneal retinaculum (thin arrows) attaching to retrotrochlear eminence and covering peroneus tendons.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —Flexor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, E, and G) and corresponding photographs of gross sections (B, D, F, and H) from anterior to posterior aspects show vertical orientation of flexor retinaculum (white arrow), which extends inferiorly from medial malleolus to superior aspect of fascia of abductor hallucis muscle. Intimate tibialis posterior (arrowhead, H) and flexor digitorum longus (black arrow, D and H) tendons are evident.

View larger version (88K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —Flexor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, E, and G) and corresponding photographs of gross sections (B, D, F, and H) from anterior to posterior aspects show vertical orientation of flexor retinaculum (white arrow), which extends inferiorly from medial malleolus to superior aspect of fascia of abductor hallucis muscle. Intimate tibialis posterior (arrowhead, H) and flexor digitorum longus (black arrow, D and H) tendons are evident.

View larger version (88K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —Flexor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, E, and G) and corresponding photographs of gross sections (B, D, F, and H) from anterior to posterior aspects show vertical orientation of flexor retinaculum (white arrow), which extends inferiorly from medial malleolus to superior aspect of fascia of abductor hallucis muscle. Intimate tibialis posterior (arrowhead, H) and flexor digitorum longus (black arrow, D and H) tendons are evident.

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —Flexor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, E, and G) and corresponding photographs of gross sections (B, D, F, and H) from anterior to posterior aspects show vertical orientation of flexor retinaculum (white arrow), which extends inferiorly from medial malleolus to superior aspect of fascia of abductor hallucis muscle. Intimate tibialis posterior (arrowhead, H) and flexor digitorum longus (black arrow, D and H) tendons are evident.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4E —Flexor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, E, and G) and corresponding photographs of gross sections (B, D, F, and H) from anterior to posterior aspects show vertical orientation of flexor retinaculum (white arrow), which extends inferiorly from medial malleolus to superior aspect of fascia of abductor hallucis muscle. Intimate tibialis posterior (arrowhead, H) and flexor digitorum longus (black arrow, D and H) tendons are evident.

View larger version (77K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4F —Flexor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, E, and G) and corresponding photographs of gross sections (B, D, F, and H) from anterior to posterior aspects show vertical orientation of flexor retinaculum (white arrow), which extends inferiorly from medial malleolus to superior aspect of fascia of abductor hallucis muscle. Intimate tibialis posterior (arrowhead, H) and flexor digitorum longus (black arrow, D and H) tendons are evident.

View larger version (77K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4G —Flexor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, E, and G) and corresponding photographs of gross sections (B, D, F, and H) from anterior to posterior aspects show vertical orientation of flexor retinaculum (white arrow), which extends inferiorly from medial malleolus to superior aspect of fascia of abductor hallucis muscle. Intimate tibialis posterior (arrowhead, H) and flexor digitorum longus (black arrow, D and H) tendons are evident.

View larger version (73K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4H —Flexor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, E, and G) and corresponding photographs of gross sections (B, D, F, and H) from anterior to posterior aspects show vertical orientation of flexor retinaculum (white arrow), which extends inferiorly from medial malleolus to superior aspect of fascia of abductor hallucis muscle. Intimate tibialis posterior (arrowhead, H) and flexor digitorum longus (black arrow, D and H) tendons are evident.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Schematic of sinus tarsi shows cervical ligament (c) and nearby root components of stem ligament of inferior extensor retinaculum: medial root (1), intermediate root (2), and lateral root (3).

View larger version (176K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —Inferior extensor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, and E) and corresponding photographs of gross sections (B, D, and F) at level of sinus tarsi show position of cervical ligament (curved arrow, A and B) and nearby medial root (thin arrows, A and B), intermediate root (thick arrow, A and B), and lateral root (chevron, A-F) of stem ligament of inferior extensor retinaculum.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —Inferior extensor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, and E) and corresponding photographs of gross sections (B, D, and F) at level of sinus tarsi show position of cervical ligament (curved arrow, A and B) and nearby medial root (thin arrows, A and B), intermediate root (thick arrow, A and B), and lateral root (chevron, A-F) of stem ligament of inferior extensor retinaculum.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —Inferior extensor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, and E) and corresponding photographs of gross sections (B, D, and F) at level of sinus tarsi show position of cervical ligament (curved arrow, A and B) and nearby medial root (thin arrows, A and B), intermediate root (thick arrow, A and B), and lateral root (chevron, A-F) of stem ligament of inferior extensor retinaculum.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —Inferior extensor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, and E) and corresponding photographs of gross sections (B, D, and F) at level of sinus tarsi show position of cervical ligament (curved arrow, A and B) and nearby medial root (thin arrows, A and B), intermediate root (thick arrow, A and B), and lateral root (chevron, A-F) of stem ligament of inferior extensor retinaculum.

View larger version (168K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6E —Inferior extensor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, and E) and corresponding photographs of gross sections (B, D, and F) at level of sinus tarsi show position of cervical ligament (curved arrow, A and B) and nearby medial root (thin arrows, A and B), intermediate root (thick arrow, A and B), and lateral root (chevron, A-F) of stem ligament of inferior extensor retinaculum.

View larger version (149K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6F —Inferior extensor retinaculum in cadaver. Sequential coronal T1-weighted MR images (A, C, and E) and corresponding photographs of gross sections (B, D, and F) at level of sinus tarsi show position of cervical ligament (curved arrow, A and B) and nearby medial root (thin arrows, A and B), intermediate root (thick arrow, A and B), and lateral root (chevron, A-F) of stem ligament of inferior extensor retinaculum.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6G —Inferior extensor retinaculum in cadaver. Sequential axial T1-weighted MR images at level of tibiotalar joint show oblique superomedial band (arrows) of inferior extensor retinaculum coursing upward and attaching to anterior crest of tibia under tibialis anterior tendon.

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6H —Inferior extensor retinaculum in cadaver. Sequential axial T1-weighted MR images at level of tibiotalar joint show oblique superomedial band (arrows) of inferior extensor retinaculum coursing upward and attaching to anterior crest of tibia under tibialis anterior tendon.

View larger version (153K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6I —Inferior extensor retinaculum in cadaver. Sequential axial T1-weighted MR images at level of tibiotalar joint show oblique superomedial band (arrows) of inferior extensor retinaculum coursing upward and attaching to anterior crest of tibia under tibialis anterior tendon.

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