Inferior Extensor Retinaculum Research Articles

Histological analysis of the structural composition of ankle ligaments.

Various ankle ligaments have different structural composition. The aim of this study was to analyze the morphological structure of ankle ligaments to further understand their function in ankle stability. One hundred forty ligaments from 10 fresh-frozen cadaver ankle joints were dissected: the calcaneofibular, anterior, and posterior talofibular ligaments; the inferior extensor retinaculum, the talocalcaneal oblique ligament, the canalis tarsi ligament; the deltoid ligament; and the anterior tibiofibular ligament. Hematoxylin-eosin and Elastica van Gieson stains were used for determination of tissue morphology. Three different morphological compositions were identified: dense, mixed, and interlaced compositions. Densely packed ligaments, characterized by parallel bundles of collagen, were primarily seen in the lateral region, the canalis tarsi, and the anterior tibiofibular ligaments. Ligaments with mixed tight and loose parallel bundles of collagenous connective tissue were mainly found in the inferior extensor retinaculum and talocalcaneal oblique ligament. Densely packed and fiber-rich interlacing collagen was primarily seen in the areas of ligament insertion into bone of the deltoid ligament. Ligaments of the lateral region, the canalis tarsi, and the anterior tibiofibular ligaments have tightly packed, parallel collagen bundles and thus can resist high tensile forces. The mixed tight and loose, parallel oriented collagenous connective tissue of the inferior extensor retinaculum and the talocalcaneal oblique ligament support the dynamic positioning of the foot on the ground. The interlacing collagen bundles seen at the insertion of the deltoid ligament suggest that these insertion areas are susceptible to tension in a multitude of directions. The morphology and mechanical properties of ankle ligaments may provide an understanding of their response to the loads to which they are subjected.

Brostrom-Gould Procedure for Lateral Ankle Instability

Acute ankle sprains are most frequently treated conservatively, although some surgeons may advocate acute repairs in certain situations. Surgery is indicated for chronic sprains with persistent ankle instability despite well-designed conservative management. Several anatomic and nonanatomic operative procedures are available. The Brostrom-Gould procedure is a widely-used operative intervention for treatment of chronic lateral ankle sprains. It consists of an anatomic repair or reconstruction of the injured lateral ankle ligament complex (Brostrom procedure), followed by suturing of the inferior extensor retinaculum to periosteum of the distal fibula (Gould modification). This article describes the standard Brostrom-Gould procedure starting with the identification of the anatomic landmarks. The skin incision follows the anterior border of the distal fibula, and careful subcutaneous dissection is carried out to expose the extensor retinaculum and the torn ligaments. This is followed by bone preparation and ligament repair utilizing a box stitch technique while holding the ankle in an appropriate position. Finally, the Gould portion of the procedure is demonstrated.

Sonographic visibility of the sinus tarsi with a 12 MHz transducer.

To assess the value of ultrasonography in studies of the ligaments within the sinus tarsi (ST) in healthy subjects. We examined 20 healthy volunteers using a 12-MHz transducer with THI and compound imaging. With the foot in inversion, the following structures were examined with coronal and transverse scans: (1) the root of the inferior extensor retinaculum (RIER); (2) the interosseous talocalcaneal ligament (ITCL); (3) the cervical ligament (CL); (4) the bifurcate ligament (BL); (5) the synovial recesses, which were examined for possible distention (distended synovial recesses, DSR). The sonographic features, orientation, and thickness of each ligament were assessed. The easiest structure to identify (visualized in 20/20 subjects) was the RIER, which formed a semiarch. The two deeper layers were hypoechoic, the superficial layer hyperechoic. The ITCL was situated posteriorly and deep with an oblique course. It appeared hypoechoic with a mean thickness of 4.06mm±0.7. It was visualized in 18/20 (90%) subjects. The CL (isoechoic/hyperechoic) was located more anteriorly at an intermediate depth. The orientation was almost vertical. It was visualized in 17/20 (85%) subjects, with a mean thickness of 2.28mm±0.34. The BL appeared hypoechoic. It was visualized in 19/20 (95%) subjects with transverse (anterior end of the ST) and longitudinal scans. The calcaneonavicular and calcaneocuboid components displayed mean (SD) thicknesses of 2.09mm±0.37 and 2.7mm±0.32, respectively. The ITCL and RIER were visualized in the same scan as a semiarch. DSR was observed in 4/20 (20%) subjects. The present study shows that, in patients with suspected ST pathology, the anatomic structures that make up this recess can be adequately examined with ultrasonography performed with ordinary 12-MHz transducers.

Feasibility and outcome of inferior extensor retinaculum reinforcement in modified Broström procedures.

The purpose of this study was to assess the feasibility of inferior extensor retinaculum (IER) reinforcement and analyze differences in clinical and radiographic outcomes based on whether or not IER reinforcement was performed in modified Broström procedures. Forty-one patients (41 ankles) who underwent ankle reconstruction with either a Broström procedure or modified Broström with IER reinforcement were included in this prospective study. During Broström procedures, feasibility of IER reinforcement was recorded. Clinical and radiographic outcomes were analyzed between modified Broström procedures (MBP group) in which IER reinforcement was feasible and Broström procedures (BP group) in which IER reinforcement was not feasible. IER reinforcement was feasible in 31 cases (75.6%) and not feasible in 10 cases (24.4%) due to anatomic variations. The American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved in the MBP group from a preoperative mean of 66.3 to a postoperative mean of 89.4. In the BP group, the score increased from 71.3 to 89.8. The radiographic outcomes assessed by stress radiographs demonstrated that talar anterior translation and talar tilt improved from 6.3 mm to 4.6 mm and from 9.0 degrees to 5.0 degrees, respectively, in the MBP group. In the BP group, talar anterior translation improved from 6.9 mm to 4.9 mm and talar tilt, from 9.5 degrees to 4.9 degrees. No statistically significant difference was observed between the 2 groups. IER reinforcement was feasible in 75.6% of patients in whom modified Broström procedures had been planned. Postoperative clinical and radiographic outcomes were not significantly different based on whether or not IER reinforcement was performed. These findings suggest that isolated ligament reconstruction without IER may be sufficient to restore ankle stability. Level II, cohort study.

Arthroscopic Broström repair with Gould augmentation via an accessory anterolateral port for lateral instability of the ankle.

Although several arthroscopic surgical techniques for the treatment of lateral instability of the ankle have been introduced recently, some concern remains over their procedural complexity, complications, and unclear clinical outcomes. We have simplified the arthroscopic technique of Broström repair with Gould augmentation. This technique requires only two small skin incisions for two ports (medial midline and accessory anterolateral ports), without needing a percutaneous procedure or extension of the skin incisions. The anterior talofibular ligament is reattached to its anatomical footprint on the fibula with suture anchor, under arthroscopic view. The inferior extensor retinaculum is directly visualized through the accessory anterolateral port and is attached to the fibula with another suture anchor under arthroscopic view via the anterolateral port. The use of two small ports offers a procedure that is simple to perform and less morbid for patients.

Arthrobrostrom Lateral Ankle Stabilization Technique: An Anatomical Study

To evaluate the proximity of anatomical structures for the Arthrobrostrom lateral ankle ligament stabilization and define ideal landmarks and “safe zone” for this repair. Ten matched-pair of human cadaveric ankle specimens were screened for the study. All specimens underwent arthroscopic lateral ligament repair according to the previously described Arthrobrostrom technique with two suture anchors in the fibula. Three cadavers were used to test our protocol and seven were dissected to determine proximity of anatomic structures. Several distances were measured including those of different anatomic structures to the suture knots in order to determine a “safe zone”. Measurements were obtained by two separate observers and statistical analysis was performed. None of the specimens revealed entrapment of the critical anatomic structures by either of the suture knots. The internervous “safe zone” between the intermediate branch of the superficial peroneal nerve (SPN) and sural nerve was a mean 48mm. The intertendinous “safe zone” between the peroneus tertius and peroneus brevis was a mean 43mm. On average, a 20mm safe distance was maintained from the most medial suture to the intermediate branch of the SPN. The amount of inferior extensor retinaculum grasped by either suture knot varied from 0mm to 8.7mm. The results indicate there is a relatively wide internervous and intertendinous “safe zone” when performing the Arthrobrostrom technique for lateral ankle stabilization. While none of the critical anatomic structures were entrapped by the suture knots it was evident that the inferior extensor retinaculum is included in a majority of the repairs. Our study further defines the proximity of adjacent anatomic structures and establishes the anatomic “safe zone” for the Arthrobrostrom lateral ankle stabilization procedure.

English

INTRODUCTION: Fibularis tertius (FT) was formerly called as the peroneus tertius 1 . FT muscle is a relatively small unipennate muscle found in the anterior compartment of the leg. It assists in dorsiflexion and eversion of foot 2 . The FT muscle originates from the distal third or more of the medial surface of fibula, the adjoining anterior surface of the interosseous membrane and the anterior crural intermuscular septum. Thereafter, tendon runs beneath the superior extensor retinaculum, inferior extensor retinaculum and gets inserted on the medial aspect of the dorsal surface of the base of the fifth metatarsal. FT muscle is supplied by the deep peroneal nerve (2, 3, and 4) . FT has been described as a part of the extensor digitorum longus (EDL) muscle in classical textbooks 2 . CASE REPORT: During routine dissection for the first MBBS students, we observed that the peroneus tertius was absent on the dorsum of the Right lower limb of a 50 years old, donated embalmed male cadaver in the Department of Anatomy, Lady Hardinge Medical College, New Delhi, India. Both the limbs were carefully observed and examined to differentiate the absence of FT muscle. There was no scar mark or sign of injury on the limb. The other muscles of the compartment were present normally with their normal anatomical features. The photographs of the dorsum of the foot were taken for proper documentation and for ready reference. The absence of the peroneus tertius is very rare and not found in literature. Usually, the peroneus tertius is involved in dorsiflexion and eversion of the foot.

Distribution of sensory nerve endings around the human sinus tarsi: a cadaver study

The aim of this study was to analyse the pattern of sensory nerve endings and blood vessels around the sinus tarsi. The superficial and deep parts of the fat pads at the inferior extensor retinaculum (IER) as well as the subtalar joint capsule inside the sinus tarsi from 13 cadaver feet were dissected. The distribution of the sensory nerve endings and blood vessels were analysed in the resected specimens as the number per cm(2) after staining with haematoxylin-eosin, S100 protein, low-affinity neurotrophin receptor p75, and protein gene product 9.5 using the classification of Freeman and Wyke. Free nerve endings were the predominant sensory ending (P<0.001). Ruffini and Golgi-like endings were rarely found and no Pacini corpuscles were seen. Significantly more free nerve endings (P<0.001) and blood vessels (P=0.01) were observed in the subtalar joint capsule than in the superficial part of the fat pad at the IER. The deep part of the fat pad at the IER had significantly more blood vessels than the superficial part of the fat pad at the IER (P=0.012). Significantly more blood vessels than free nerve endings were seen in all three groups (P<0.001). No significant differences in distribution were seen in terms of right or left side, except for free nerve endings in the superficial part of the fat pad at the IER (P=0.003). A greater number of free nerve endings correlated with a greater number of blood vessels. The presence of sensory nerve endings between individual fat cells supports the hypothesis that the fat pad has a proprioceptive role monitoring changes and that it is a source of pain in sinus tarsi syndrome due to the abundance of free nerve endings.

Biomechanical Comparison of an All-Soft Suture Anchor With a Modified Broström-Gould Suture Repair for Lateral Ligament Reconstruction

Background: Anatomic repair is indicated for patients who have recurrent lateral ankle instability despite nonoperative measures. Hypothesis: There is no difference in repair stiffness, failure torque, or failure angle between specimens repaired with all-soft suture anchors versus the modified Broström-Gould technique with sutures only. Study Design: Controlled laboratory study. Methods: In 10 matched pairs of human cadaveric ankles, the anterior talofibular ligament (ATFL) was incised from its origin on the fibula. After randomization, 1 ankle was repaired to its anatomic insertion using two 1.4-mm JuggerKnot all-soft suture anchors; the other ankle was repaired with a modified Broström-Gould technique using 2-0 FiberWire. All were augmented using the inferior extensor retinaculum. All ankles were mounted to the testing machine in 20° of plantar flexion and 15° of internal rotation and loaded to failure after the repair. Stiffness, failure torque, and failure angle were recorded and compared using a paired Student t test with a significance level set at P < .05. Results: There was no significant difference in failure torque, failure angle, or stiffness. No anchors pulled out of bone. The primary mode of failure was pulling through the ATFL tissue. Conclusion: There was no statistical difference in strength or stiffness between a 1.4-mm all-soft suture anchor and a modified Broström-Gould repair with 2-0 FiberWire. The primary mode of failure was at the tissue level rather than knot failure or anchor pullout. Clinical Relevance: The particular implant choice (suture only, tunnel, anchor) in repairing the lateral ligament complex may not be as important as the time to biological healing. The suture-only construct as described in the Broström-Gould repair was as strong as all-soft suture anchors, and the majority of the ankles failed at the tissue level. For those surgeons whose preference is to use anchor repair, this novel all-soft suture anchor may be an alternative to other larger anchors, as none failed by pullout.

Ligament Structures in the Tarsal Sinus and Canal

The concrete anatomy and functional characteristics of the subtalar ligaments have been a matter of debate that some believe has hampered the progress of clinical ligament reconstruction. In 32 fresh-frozen cadaver feet, the course of the inferior extensor retinaculum (IER) and other subtalar ligaments was carefully measured and photographed both from the portal of the tarsal sinus and from a posterior view. The IER inserted inside the tarsal sinus and canal by means of 3 roots: a lateral, an intermediate, and a medial one. These roots, along with the tarsal canal, divided the subtalar space into 3 parts. In front of the IER and inside the tarsal sinus, the thick cervical ligament (CL) lay at a 45-degree angle to the calcaneus. Behind the IER and inside the posterior capsule, in most cases (25 of 32 specimens), the posterior capsular ligament (PCaL) lay directly in front of the posterior talocalcaneal facet. Inside the tarsal canal, the fan-shaped medial root of the IER spread from outside upper lateral to lower medial, and the interosseous talocalcaneal ligament (ITCL) ran from upper medial to lower lateral; fibers of these 2 ligaments blended tightly together to form a V-shaped ligament complex. Just anterior to this complex in some cases (20 of 32 specimens), a short narrow upright ligament, the tarsal canal ligament (TCL), was located behind the middle talocalcaneal joint. The results of this study show that the CL is the primary ligament in the tarsal sinus and that the ITCL is a thin single band rather than a strong bilaminar ligament located inside the tarsal canal. Instead, the medial root of the IER is the primary ligamentous structure in the tarsal canal. The anatomical description provided here may provide a more accurate theoretical foundation for clinical subtalar stability restoration.

Comparative Analysis of Inter- and Intraligamentous Distribution of Sensory Nerve Endings in Ankle Ligaments

The aim of this study was to analyze the inter-, intraligamentous, and side-related patterns of sensory nerve endings in ankle ligaments. A total of 140 ligaments from 10 cadaver feet were harvested. Lateral: calcaneofibular, anterior-, posterior talofibular; sinus tarsi: lateral- (IERL), intermediate-, medial-roots inferior extensor retinaculum, talocalcaneal oblique and canalis tarsi (CTL); medial: tibionavicular (TNL), tibiocalcaneal (TCL), superficial tibiotalar, anterior/posterior tibiotalar portions; syndesmosis: anterior tibiofibular. Following immunohistochemical staining, the innervation and vascularity was analyzed between ligaments of each anatomical complex, left/right feet, and within the 5 levels of each ligament. Significantly more free nerve endings were seen in all ligaments as compared to Ruffini, Pacini, Golgi-like, and unclassifiable corpuscles (P ≤ .005). The IERL had significantly more free nerve endings and blood vessels than the CTL (P ≤ .001). No significant differences were seen in the side-related distribution, except for Ruffini endings in right TCL (P = .016) and unclassifiable corpuscles in left TNL (P = .008). The intraligamentous analysis in general revealed no significant differences in mechanoreceptor distribution. The IERL at the entrance of the sinus tarsi contained more free nerve endings and blood vessels, as compared to the deeper situated CTL. Despite different biomechanical functions in the medial and lateral ligaments, the interligamentous distribution of sensory nerve endings was equal. The intrinsic innervation patterns of the ankle ligaments provides an understanding of their innate healing capacities following injury as well as the proprioception properties in postoperative rehabilitation.

Biomechanical Analysis of Brostrom Versus Brostrom-Gould Lateral Ankle Instability Repairs

The traditional Brostrom repair and the modified Brostrom-Gould repair are 2 historically reliable procedures used to address lateral ankle instability. The purpose of this study was to evaluate the biomechanical stability conferred by the Brostrom repair as compared to the Brostrom-Gould modification in an unstable cadaveric ankle model. A total of 10 cadaveric specimens were placed in a Telos ankle stress apparatus in an anterior-posterior position and then in a lateral position, while a 170 N load was applied to simulate anterior drawer (AD) and talar tilt (TT) tests, respectively. In both circumstances, the ankle was held in 15 degrees of plantarflexion, neutral, and 15 degrees of dorsiflexion, while the movement of the sensors was measured using a video motion analysis system. Measurement of the translation between the talus and tibia in the AD test and the angle between the tibia and talus in the TT test were calculated for specimens in the (1) intact, (2) sectioned (division of the ATFL and CFL), (3) Brostrom repair and (4) Gould modification states. When compared to both the repaired states and the intact states, the sectioned state demonstrated increased inversion and translation at all ankle positions during TT and AD testing. Furthermore, no significant differences were found between the intact state and either of the repaired states. Finally, no difference in the biomechanical stability could be identified between the traditional Brostrom repair and the modified Brostrom-Gould procedure. Our findings indicate that there is no significant biomechanical difference in initial ankle stability conferred by augmenting the traditional Brostrom repair with the Gould modification in this time-zero cadaveric model. These data suggest that the additional reinforcement of an ankle's lateral ligament complex repair of the ankle with the inferior extensor retinaculum may be marginal at the time of surgery.

Ligaments of the tarsal sinus: improved detection, characterisation and significance in the paediatric ankle with 3-D proton density MR imaging

No study in the paediatric literature--and only a single study in all of the literature--has evaluated the visualization frequency of the sinus tarsi ligaments on MRI. That 20-year-old study demonstrated only limited visualisation. The objective of this study is to re-evaluate the visualisation frequency of the sinus tarsi ligaments and to characterise their morphology on isotropic three-dimensional proton density imaging (3-D-PD). The authors hypothesise that by using 3-D-PD, these ligaments will be able to be demonstrated in nearly all paediatric patients. Patients were scanned on either 1.5- or 3-Tesla scanners using 3-D-PD. Of 174 patients reviewed, 50 were identified who met inclusion and exclusion criteria. The interosseous talocalcaneal ligament (ITC), the cervical ligament (CL) and the roots of the inferior extensor retinaculum (IER) were successfully visualised and characterised in three planes in 50 out of 50 children. The mean ligament thickness was 4.22 mm for the ITC, 2.74 mm for the CL and 1.04 mm for the IER roots. With modern parameters, the tarsal sinus ligaments can be visualised in 100% of patients, a percentage substantially higher than previously reported.

Immunohistochemical Analysis of Sensory Nerve Endings in Ankle Ligaments: A Cadaver Study

Background: The aim of this study was to analyze the pattern and types of sensory nerve endings in ankle ligaments using immunohistochemical techniques, in order to gain more insight into functional ankle stability. Methods: One hundred forty ligaments from 10 cadaver feet were included: the calcaneofibular and anterior/posterior talofibular ligaments from the lateral complex; inferior extensor retinaculum complex, talocalcaneal oblique and canalis tarsi ligaments from the sinus tarsi; deltoid ligament with its individual portions from the medial complex, and anterior tibiofibular ligament (ATiFL) from the syndesmosis. Mechanoreceptors were classified according to Freeman and Wyke [Acta Anat (Basel) 1967;68:321–333] after staining with hematoxylin-eosin, low-affinity neurotrophin receptor p75, protein gene product 9.5, and S-100 protein. Results: Free nerve endings were the predominant sensory endings in all four complexes, with the greatest density in the lateral and medial complexes; followed by Ruffini endings, unclassifiable corpuscles, Pacini corpuscles, and Golgi-like endings. Ruffini endings were significantly more prevalent in the ATiFL than in the medial complex, and more common than Pacini corpuscles and Golgi-like endings in the lateral, medial, and sinus tarsi complexes. A greater number of blood vessels correlated with a greater number of free nerve endings. There was a negative correlation between the number of Ruffini endings, unclassifiable corpuscles, and age. Conclusions: Free nerve endings are the dominant mechanoreceptor type in the ankle ligaments, followed by Ruffini endings. The ligaments of the lateral and medial ankle complexes are more innervated than the sinus tarsi ligaments.

Long-Term Results after Modified Brostrom Procedure without Calcaneo-fibular Ligament Reconstruction

The short-term results of modified Brostrom procedures (MBP) have been satisfactory. However, the long-term results of anatomical reconstruction have been less frequently reported. We report on our long-term results in our patient group. Thirty patients with chronic ankle instability who were treated using the MBP without CFL reconstruction from March 1997 to June 1999 were evaluated retrospectively. This consecutive series of patients was comprised of 26 males and four females. The mean age of the patients at the time of operation was 23 years. The mean followup period was 10.6 years. Twenty-four of the 30 were high-level amateur or professional athletes. The operation procedure involved only ATFL imbrication with inferior extensor retinaculum (IER) reinforcement. Clinical outcomes were evaluated by reviewing clinical charts, retrospectively. Functional outcome scores were obtained using the Hamilton scale, a VAS, and AOFAS score at final followup visit, when each patient underwent a physical examination and stress radiography. Mean AOFAS score was 91 and the mean VAS at final followup was 87. According to the Hamilton classification, 12 achieved an excellent result, 16 a good result, and two a fair result. Mean anterior translation values at final followup were 6.9 and 6.1 mm on ipsilateral and contralateral sides. Furthermore, mean talar tilt angles were 3.0 and 2.5 degrees for ipsilateral and contralateral sides. Twenty-eight of the 30 patients were restored to pre-injury activity levels. The long-term surgical results of the MBP without CFL reconstruction for chronic lateral ankle instability were good to excellent in terms of functional, clinical, and radiographic assessments.

Extensor tendoscopy of the ankle

The extensor digitorum longus muscle (EDL) arises from the upper three-quarters of the extensor surface of the fibula, the interosseous septum and from a small area of the tibia across the superior tibiofibular joint. It forms its four tendons which are restrained by the superior and inferior extensor retinacula. The two retinacula prevent the EDL and extensor hallucis longus (EHL) tendons from bow stringing. The inferior extensor retinaculum also contributes to the stability of the subtalar joint. Extensor tendoscopy has been performed in 3 patients and no neural injury was noted.

Anterior tarsal tunnel syndrome secondary to missed talus fracture: a case report

The anterior tarsal tunnel syndrome (ATTS) has first been described by Kopell and Thompson in 1963. The anterior tarsal tunnel is formed by the fascia lining the inferior extensor retinaculum and talus as well as the navicular bone. Many ATTS cases with various etiologies have been reported since the first description. We report here an ATSS case resulting from a fibro-osseous structure that occurred after a missed talus fracture. The ATTS diagnosis can be made with a comprehensive clinical neurological examination and electrophysiological study. The treatment is based on the underlying etiology, while surgery is the most common treatment providing successful outcomes in the long term.

Ultrasound of the ankle.

Ultrasound of the ankle.

Portal safety and efficacy of anterior subtalar arthroscopy: a cadaveric study

Anterior subtalar arthroscopy was performed in 14 feet of 7 cadaveric bodies using the primary visualization and working portals. The cartilage of the anterior/middle calcaneal facet that can be reached was marked. The feet were dissected and the distances between the portals and surrounding cutaneous nerves were measured. Any damage to the ligaments of the sinus tarsi was noted. The percentage area of the articular cartilage that was marked was measured. In all specimens, the primary visualization portal tract passed through the lateral root of the inferior extensor retinaculum. The primary working portal tract passed through the lateral root in nine specimens (64%). Cervical ligament was intact in all specimens. In three specimens (21%), the primary visualization portal tract passed through the posterior edge of the intermediate root of the inferior extensor retinaculum. The interosseous talocalcaneal ligament was intact in all specimens. The primary visualization portal tract passed through the medial root of the inferior extensor retinaculum in eight specimens (57%). The primary working portal tract passed through the medial root of the inferior extensor retinaculum in one specimen. The average working area on the calcaneal facet was 95% +/- 4% of the total articular surface. There was no case of nerve injury in all specimens. In conclusion, anterior subtalar arthroscopy is a minimally invasive approach to deal with pathologies of this joint without the need of extensive resection of the ligamentous structures of the sinus tarsi.

Sustantial Observation on Foot Taeyang Meridian Muscle in Human Lower Limb from a Anatomical Viewpoint

Objective : This study was carried to identify the anatomical component of FTMM(Foot Taeyang Meridian Muscle) in human lower limb, and further to help the accurate application to real acupunc- ture. Methods : FTM at the surface of the lower limb was labelled with latex. And cadaver was stripped off to demonstrate muscles, nerves and the others and to display the internal structures of FTMM, being divided into outer, middle, and inner layer. Results : FTMM in human lower limb is composed of muscles, nerves, ligaments etc. The internal composition of the FTMM in human lower limb are as follows : 1) Muscle : Gluteus maximus. biceps femoris, semitendinosus, gastrocnemius, triceps calf, fibularis brevis tendon, superior peroneal retinacula, calcaneofibular ligament, inferior extensor retinaculum, abductor digiti minimi, sheath of flexor tendon at outer layer, biceps femoris, semimembranosus, plantaris, soleus, posterior tibialis, fibularis brevis, extensor digitorum brevis, flexor digiti minimi at middle layer, and for the last time semimembranosus, adductor magnus, plantaris, popliteus, posterior tibialis, flexor hallucis longus, dorsal calcaneocuboidal ligament at inner layer. 2) Nerve : Inferior cluneal nerve, posterior femoral cutaneous n., sural cutaneous n., proper plantar branch of lateral plantar n. at outer layer, sciatic nerve, common peroneal n., medial sural cutaneous n., tibial n. at middle layer, and for the last time tibial nerve, flexor hallucis longus branch of tibial n. at inner layer. Conclusions : This study proves comparative differences from already established studies from the viewpoint of constituent elements of FTMM in the lower limb, and also in the aspect of substantial assay method. We can guess that there are conceptional differences between terms (that is, nerves which control muscles of FTMM and those which pass near by FTMM) in human anatomy.