Anatomical Investigation of the Flexor Retinaculum Covering the Tarsal Tunnel in Formaldehyde-Fixed Cadavers

Year 2023, Volume: 25 Issue: 3, 269 - 272, 30.12.2023

Hilal Akdemir Aktaş , Mine Farımaz , Sinem Akkaşoğlu , Zeynep Bengisu Kaya

https://doi.org/10.18678/dtfd.1329746

Abstract

Aim: The flexor retinaculum lies between the medial malleolus of the tibia and the medial process of the calcaneus. It converts grooves on the tibia and calcaneus into the tarsal tunnel. The aim of this study was to analyze the morphometry, the course, and the shape of the flexor retinaculum covering the tarsal tunnel in formaldehyde-fixed cadavers.
Material and Methods: Six lower extremities of four formaldehyde-fixed cadavers (four right sides, and 2 left sides) were examined to evaluate the morphometry of the flexor retinaculum. The cadavers were two females and two males with an age range of 60-89 years. A digital caliper (150 mm) and a light microscope were used for measuring parameters. The central length, proximal, midpoint, and distal width, thickness, course, and shape of the flexor retinaculum were examined in this study.
Results: The mean central length of the flexor retinaculum was found 42.26±5.18 mm. The mean proximal, midpoint, and distal width of the flexor retinaculum were 29.29±7.29 mm, 29.92±3.66 mm, and 29.76±8.13 mm, respectively. The mean of the thickness was measured at 234.94 µm. The flexor retinaculum coursed vertically in four extremities and coursed obliquely in two extremities. The shape of the retinaculum was triangular in five extremities and quadrangular in only one extremity.
Conclusion: The morphometric data obtained from this study can help surgeons during the operations of the tarsal tunnel syndrome. To our knowledge, the width and course of the flexor retinaculum were examined for the first time in this study.

Keywords

Flexor retinaculum, ankle joint, tarsal tunnel syndrome, morphometry

Formaldehit Fikse Kadavralarda Tarsal Tüneli Kaplayan Retinaculum Flexorum'un Anatomik Olarak İncelenmesi

Abstract

Amaç: Retinaculum flexorum, tibia'nın malleolus medialis'i ile calcaneus'un processus medialis'i arasında uzanır. Retinaculum flexorum, tibia ve calcaneus üzerindeki olukları tarsal tünele dönüştürür. Bu çalışmanın amacı, formaldehit fikse kadavralarda tarsal tüneli kaplayan retinaculum flexorum’un morfometrisini, seyrini ve şeklini incelemektir.
Gereç ve Yöntemler: Dört formaldehit fikse kadavraya ait olan altı adet alt ekstremite (dört sağ taraf ve iki sol taraf), retinaculum flexorum morfometrisini değerlendirmek için incelendi. Yaş aralığı 60-89 yıl arasında olan kadavraların ikisi kadın ve ikisi ise erkek idi. Parametrelerin ölçümü için bir dijital kumpas (150 mm) ve bir ışık mikroskobu kullanıldı. Bu çalışmada retinaculum flexorum’un santral uzunluğu, proksimal, orta nokta ve distal genişliği ile kalınlığı, seyri ve şekli incelendi.
Bulgular: Retinaculum flexorum’un ortalama santral uzunluğu 42,26±5,18 mm olarak bulundu. Retinaculum flexorum’un proksimal, orta nokta ve distal ortalama genişliği ise sırasıyla 29,29±7,29 mm, 29,92±3,66 mm ve 29,76±8,13 mm olarak ölçüldü. Retinaculum flexorum’un kalınlığı ortalama olarak 234,94 µm olarak bulundu. Retinaculum flexorum’un seyri, dört ekstremitede dikey ve iki ekstremitede ise oblik olarak bulundu. Retinaculum’un şekli beş ekstremitede üçgen ve sadece bir ekstremitede ise dörtgen idi.
Sonuç: Bu çalışmadan elde edilen morfometrik veriler tarsal tünel sendromu ameliyatları sırasında cerrahlara yardımcı olacaktır. Bildiğimiz kadarıyla retinaculum flexorum’un genişliği ve seyri ilk kez bu çalışmada incelenmiştir.

Keywords

Retinaculum flexorum, Articulatio talocruralis, Tarsal tünel sendromu, Morfometri

References

• Numkarunarunrote N, Malik A, Aguiar RO, Trudell DJ, Resnick D. Retinacula of the foot and ankle: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol. 2007;188(4):W348-54.
• Standring S. Gray's anatomy e-book: the anatomical basis of clinical practice. Elsevier; 2021.
• Demondion X, Canella C, Moraux A, Cohen M, Bry R, Cotten A. Retinacular disorders of the ankle and foot. Semin Musculoskelet Radiol. 2010;14(3):281-91.
• Lau JT, Daniels TR. Tarsal tunnel syndrome: a review of the literature. Foot Ankle Int. 1999;20(3):201-9.
• Ferkel E, Davis WH, Ellington JK. Entrapment neuropathies of the foot and ankle. Clin Sports Med. 2015;34(4):791-801.
• Stecco C, Macchi V, Porzionato A, Morra A, Parenti A, Stecco A, et al. The ankle retinacula: morphological evidence of the proprioceptive role of the fascial system. Cells Tissues Organs. 2010;192(3):200-10.
• El Shazly O, El Shazly A, Desouky A, El Zohiery AK, Sakr HM: Anatomical bases of endoscopic tarsal tunnel release: anatomical and ultra-sonographic study with a preliminary clinical report. Surg Radiol Anat. 2011;33(10):929-36.
• Cansü CE, Özturan K, Yücel İ. Bilateral tarsal tunnel syndrome due to bilateral lipoma: a case report. Duzce Med J. 2010;12(3):65-7. Turkish.
• McSweeney SC, Cichero M: Tarsal tunnel syndrome-A narrative literature review. Foot (Edinb). 2015;25(4):244-50.
• Kopell HP, Thompson WA. Peripheral entrapment neuropathies of the lower extremity. N Engl J Med. 1960;262:56-60.
• Singh G, Kumar VP. Neuroanatomical basis for the tarsal tunnel syndrome. Foot Ankle Int. 2012;33(6):513-8.
• Ahmad M, Tsang K, Mackenney PJ, Adedapo AO. Tarsal tunnel syndrome: A literature review. Foot Ankle Surg. 2012;18(3):149-52.
• Doneddu PE, Coraci D, Loreti C, Piccinini G, Padua L. Tarsal tunnel syndrome: still more opinions than evidence. Status of the art. Neurol Sci. 2017;38(10):1735-9.
• Park SE, Kim JC, Ji JH, Kim YY, Lee HH, Jeong JJ. Post-traumatic pseudoaneurysm of the medial plantar artery combined with tarsal tunnel syndrome: two case reports. Arch Orthop Trauma Surg. 2013;133(3):357-60.
• Molloy AP, Lyons R, Bergin D, Kearns SR. Flexor digitorum accessorius causing tarsal tunnel syndrome in a paediatric patient: a case report and review of the literature. Foot Ankle Surg. 2015;21(2):e48-50.
• Deleu PA, Bevernage BD, Birch I, Maldague P, Gombault V, Leemrijse T. Anatomical characteristics of the flexor digitorum accessorius longus muscle and their relevance to tarsal tunnel syndrome: a systematic review. J Am Podiatr Med Assoc. 2015;105(4):344-55.
• Mattos I, Ubillus HA, Campos G, Soares S, Azam MT, Oliva XM, et al. Anatomy of the tibial nerve in relation to the tarsal tunnel: A cadaveric study. Foot Ankle Surg. 2022;28(8):1415-20.
• Szaro P, Ghali Gataa K, Polaczek M, Ciszek B. The flexor retinaculum connects the surrounding structures into the medial ankle complex. Appl Sci. 2020;10(22):7972.