8d. The Fasciæ Around the Ankle

Fibrous bands, or thickened portions of the fascia, bind down the tendons in front of and behind the ankle in their passage to the foot. They comprise three ligaments, viz., the transverse crural, the cruciate crural and the laciniate; and the superior and inferior peroneal retinacula. 1

FIG. 441– The mucous sheaths of the tendons around the ankle. Lateral aspect. (See enlarged image) Transverse Crural Ligament (ligamentum transversum cruris; upper part of anterior annular ligament) (Fig. 441).—The transverse crural ligament binds down the tendons of Extensor digitorum longus, Extensor hallucis longus, Peronæus tertius, and Tibialis anterior as they descend on the front of the tibia and fibula; under it are found also the anterior tibial vessels and deep peroneal nerve. It is attached laterally to the lower end of the fibula, and medially to the tibia; above it is continuous with the fascia of the leg. 2 Cruciate Crural Ligament (ligamentum cruciatum cruris; lower part of anterior annular ligament) (Figs. 441, 442).—The cruciate crural ligament is a Y-shaped band placed in front of the ankle-joint, the stem of the Y being attached laterally to the upper surface of the calcaneus, in front of the depression for the interosseous talocalcanean ligament; it is directed medialward as a double layer, one lamina passing in front of, and the other behind, the tendons of the Peronæus tertius and Extensor digitorum longus. At the medial border of the latter tendon these two layers join together, forming a compartment in which the tendons are enclosed. From the medial extremity of this sheath the two limbs of the Y diverge: one is directed upward and medialward, to be attached to the tibial malleolus, passing over the Extensor hallucis longus and the vessels and nerves, but enclosing the Tibialis anterior by a splitting of its fibers. The other limb extends downward and medialward, to be attached to the border of the plantar aponeurosis, and passes over the tendons of the Extensor hallucis longus and Tibialis anterior and also the vessels and nerves. 3 Laciniate Ligament (ligamentum laciniatum; internal annular ligament).—The laciniate ligament is a strong fibrous band, extending from the tibial malleolus above to the margin of the calcaneus below, converting a series of bony grooves in this situation into canals for the passage of the tendons of the Flexor muscles and the posterior tibial vessels and tibial nerve into the sole of the foot. It is continuous by its upper border with the deep fascia of the leg, and by its lower border with the plantar aponeurosis and the fibers of origin of the Abductor hallucis muscle. Enumerated from the medial side, the four canals which it forms transmit the tendon of the Tibialis posterior; the tendon of the Flexor digitorum longus; the posterior tibial vessels and tibial nerve, which run through a broad space beneath the ligament; and lastly, in a canal formed partly by the talus, the tendon of the Flexor hallucis longus. 4

FIG. 442– The mucous sheaths of the tendons around the ankle. Medial aspect. (See enlarged image) Peroneal Retinacula.—The peroneal retinacula are fibrous bands which bind down the tendons of the Peronæi longus and brevis as they run across the lateral side of the ankle. The fibers of the superior retinaculum (external annular ligament) are attached above to the lateral malleolus and below to the lateral surface of the calcaneus. The fibers of the inferior retinaculum are continuous in front with those of the cruciate crural ligament; behind they are attached to the lateral surface of the calcaneus; some of the fibers are fixed to the peroneal trochlea, forming a septum between the tendons of the Peronæi longus and brevis. 5

The Mucous Sheaths of the Tendons Around the Ankle.—All the tendons crossing the ankle-joint are enclosed for part of their length in mucous sheaths which have an almost uniform length of about 8 cm. each. On the front of the ankle (Fig. 441) the sheath for the Tibialis anterior extends from the upper margin of the transverse crural ligament to the interval between the diverging limbs of the cruciate ligament; those for the Extensor digitorum longus and Extensor hallucis longus reach upward to just above the level of the tips of the malleoli, the former being the higher. The sheath of the Extensor hallucis longus is prolonged on to the base of the first metatarsal bone, while that of the Extensor digitorum longus reaches only to the level of the base of the fifth metatarsal. On the medial side of the ankle (Fig. 442) the sheath for the Tibialis posterior extends highest up—to about 4 cm. above the tip of the malleolus—while below it stops just short of the tuberosity of the navicular. The sheath for Flexor hallucis longus reaches up to the level of the tip of the malleolus, while that for the Flexor digitorum longus is slightly higher; the former is continued to the base of the first metatarsal, but the latter stops opposite the first cuneiform bone. 6 On the lateral side of the ankle (Fig. 441) a sheath which is single for the greater part of its extent encloses the Peronæi longus and brevis. It extends upward for about 4 cm. above the tip of the malleolus and downward and forward for about the same distance. 7

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