Ankle Injuries
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.
Retinacula also act as part of a pulley system increasing mechanical advantage.
From the second perspective, retinacula 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.
Achilles Tendonitis (or Tendinopathy) is often treated very poorly and achieves only limited positive results. This is because the practitioner often take the perspective of only treating the “areas that hurt” without evaluating concerns in the rest of the body.
To really resolve Achilles Tendonitis, practitioners need to look at the entire kinetic chain. By looking at the kinetic chain, you consider the biomechanics of all the structures involved, from the foot right up to the hip, on both the front and back of the body.
-
In the weekend warrior who suddenly increases his or her physical activity, or suddenly starts a new sport without proper training, stretching, or preparation.
-
In women who have changed from wearing high heels to low heels. In such situations, the Achilles tendon has become accustomed to remaining in a shortened position and is unable to adapt to the stretching required by wearing flat shoes.
-
In athletes who suffer from over pronation, inflexibility, or lack of strength. Weakness in the gastrocnemius and soleus muscles can cause abnormal pronation during the stance phase of the normal gait cycle.
-
In runners who increase their mileage too rapidly, who attempt hill training without proper strengthening exercises, or who are using sub-standard running gear.
-
In people with weak or unstable calf muscles, who suddenly place increased stress upon their Achilles tendon. A tight muscle is a weak muscle. Runners with weak or unstable calf muscles place increased stress upon their Achilles Tendon.
The repetitive stresses caused by walking, running, cycling, or other sports can cause friction and inflammation in the area of the Achilles Tendon.
The body responds to this inflammation by laying down scar tissue (adhesive tissue) in an attempt to stabilize the area. Inflexibility is often caused by the build-up of these adhesions, either within the soft-tissue, or within structures above or below the tendon’s kinetic chain.
An ankle sprain refers to the tearing of the ligaments of the ankle and account for approximately 40% of all athletic injuries. 85% of ankle sprains occur on the outside (lateral side) of the ankle and are known as an inversion sprain. This is the type of injury that most runners experience when they sprain their ankles. Medial ankle sprains (along the inside of the ankle) occur less frequently and are usually caused by fractures or other traumatic events.
So, why is an inversion sprain so common? You can put it down to our lopsided anatomy! The bone on the lower outside of the ankle (the lateral malleolus – distal fibula) extends further down than the bone on the inside of the ankle (medial malleolus – fibula). This difference gives the inside of the ankle (medial side) more stability than the outside of the ankle (lateral side).
At a symptomatic level, most ankle sprains appear to resolve completely without rehabilitation. In reality, ankle sprains that have not been rehabilitated correctly are usually susceptible to further injury.
An injury to the Flexor Hallucis Longus (FHL) tendon causes medial ankle pain or pain on the bottom of the foot. FHL injury is a condition that is often overlooked or misdiagnosed. This injury affects dancers, runners, soccer players, and any other athlete who performs repeated, propulsive forces, or jumping. Injury of the FHL muscle is sometimes called “Dancer’s tendonitis” but it is not solely limited to dancers.
The FHL muscle allows you to point your big toe (plantar-flexion of the big toe) and stabilizes the subtalar joint. The subtalar joint is located between two bones in your ankle – the talus and the calcaneus.
The subtalar Joint allows movement of the heel toward the medial plane (inversion) as well as movement of the heel towards the lateral plane (eversion).
