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Localisation and injection of the sinus tarsi can be challenging, particularly for the less experienced musculoskeletal sonographer/practitioner. The inferior extensor retinaculum arises from the sinus tarsi in the form of three roots (medial, intermediate and lateral) which are collectively termed the frondiform ligament. This is readily identified on ultrasound and can be used as a reference point to aid the safe delivery of injectate material into the sinus tarsi. This article describes the technique and its anatomical basis.

Background: Although several arthroscopic surgical techniques for the treatment of chronic ankle instability (CAI) have been introduced recently, the effect of inferior extensor retinaculum (IER) augmentation remains unclear. Purpose: To compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair according to whether additional IER augmentation was performed or not. Study Design: Cohort study; Level of evidence, 3. Methods: We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair surgery for CAI between 2016 and 2018. The mean age of the patients was 35.2 years (range, 19-51 years), and the mean follow-up period was 32.6 months (range, 24-48 months). Patients were divided into 2 groups according to the surgical technique used for CAI: arthroscopic ATFL repair (group A; n = 37) and arthroscopic ATFL repair with additional IER augmentation (group R; n = 45). The pain visual analog scale, American Orthopaedic Foot & Ankle Society score, Foot and Ankle Outcome Score, and the Karlsson Ankle Function Score were measured as subjective outcomes, and posturographic analysis was performed using a Tetrax device as an objective outcome. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view magnetic resonance imaging (MRI). Results: Out of 101 patients, 19 (18.5%) were excluded per the exclusion criteria, and 82 were evaluated. We identified 6 retears (7.3%) based on postoperative MRI evaluation. All patients who had ATFL retear on MRI (8.1% [3/37] in group A and 6.7% [3/45] in group R) demonstrated recurrent CAI with functional discomfort and anterior displacement >3 mm as compared with the intact contralateral ankle. All clinical scores and posturography results were improved after surgery in both groups ( P < .001). However, there were no significant differences in the clinical results and radiologic findings between the groups. Conclusion: The clinical and radiologic outcomes of patients with CAI improved after all-inside arthroscopic ATFL repair. However, additional IER augmentation after arthroscopic ATFL repair did not guarantee better clinical outcomes.

The primary aim of our study was to evaluate the strength of ankle evertor muscles in patients who have undergone a lateral ankle ligamentoplasty (which combined tensioning of the primary ligament group and reinforcing it with a pediculated extensor retinaculum flap), using 2 measurement systems (isokinetic and the functional weightbearing test [MyoLux). Our hypothesis was the strength of evertor muscles on the treated side was comparable to that of the contralateral healthy side. This prospective study included 23 patients who had chronic ankle instability and underwent an inferior extensor retinaculum flap ligamentoplasty. Clinical and functional results were assessed using the American Orthopaedic Foot & Ankle Society and Karlsson scores. The evertor muscle strength was analyzed, in both treated and healthy contralateral ankles, using isokinetic testing (gold standard) - an open kinetic chain test and a functional closed kinetic chain test (MyoLux). Data were interpreted using the Stata 14.0 software. The American Orthopaedic Foot & Ankle Society score was 88.1 ± 4.5, and the Karlsson score was 89.6 ± 4.0. Isokinetic tests did not show any significant difference between the treated ankles and the healthy one. Functional tests measuring inversion control at the ankle did not demonstrate any functional differences between the 2 ankles. As confirmed by good functional scores and the lack of difference in evertor muscle strength, this study reports that the inferior extensor retinaculum flap ligamentoplasty is a satisfactory treatment of chronic ankle instability. In addition, the MyoLux is a reliable and effective test to properly assess proprioception at the ankle.

Ligament injuries around the subtalar, talocalcaneonavicular, and calcaneocuboid joints are often underestimated on clinical and imaging findings during investigation of patients with ankle and foot injuries. Because a delayed diagnosis of midtarsal ligament tears may lead to chronic pain and functional disability, an in-depth knowledge of the complex regional anatomy and of the appropriate ultrasound scanning technique is a prerequisite for evaluating these structures and avoiding misdiagnoses. The objective of this article is twofold: to describe the relevant anatomy and biomechanics related to the ligaments that stabilize the subtalar, talocalcaneonavicular, and calcaneocuboid joints, and to illustrate reasoned landmark-based scanning techniques to provide a systematic examination of these ligaments and thus make ultrasound an effective tool for assessment of patients with suspected subtalar or midtarsal sprain.

Purpose The Brostrom-Gould procedure is currently the gold standard surgical choice for the treatment of chronic ankle instability; it can significantly improve ankle function and stability in patients. However, recent studies have reported doubts regarding the feasibility of the inferior extensor retinaculum (IER) after Brostrom-Gould and therapeutic effects compared with the Brostrom procedure. The purpose of the present study was to observe the anatomical characteristics of the lateral part of the IER using cadaveric bodies in order to guide the surgical operation of chronic ankle instability.Methods Twenty-three cadaveric ankles were dissected. The morphology of the IER and its internal structure was observed and recorded for each ankle. The shortest distance between the Stem ligament of the IER and the anterior fibular periosteum (AFP) was measured and recorded, then attempts were made to suture the Stem to the AFP.Results Twelve of the cadaveric ankles were observed as having an oblique superolateral band (OSLB) that had a tough texture upward of the lateral IER connecting with SL, as are the characteristics of the oblique superolateral band (OSLB) reported in previous studies. The inner and outer membrane of the OSLB were connected with inner and outer membrane of Stem. The average value of the distance between the Stem and AFP was 11.60±2.71mm, and the maximum and the minimum distance were 19.04mm and 6.53mm, respectively. The P -value (P=0.2) resulting from a single sample K-S test confirmed that the distribution of distances conformed to normality. None of the SL in the study could be sutured to the AFP. Conclusion The OSLB of the IER has a tough texture and connects with the Stem, and has the potential be utilised in the Brostrom-Gould procedure. However, we do not recommend utilization of the Stem in this operation regardless of the distance between the AFP and the Stem. When the Stem cannot be used to enhance repair in this operation, other solutions can be used for strengthening and to protect the repaired ATFL.

An anatomical repair procedure with augmentation of the collateral lateral ligament of the ankle is presented in this chapter. This technique combines the reinsertion of the remnants lateral ligaments of the ankle (anterior talofibular ATFL and calcaneofibular ligaments, CFL) with an augmentation using an inferior extensor retinaculum flap (IERF).

The extensor retinaculum is a reinforcement of the anterior crural fascia. Usually includes the superior extensor retinaculum and inferior extensor retinaculum which are both in continuity with the anterior fascia of the leg. Herein, there will be presented details of anatomy and clinical implications of these structures in the topic of lateral ankle instability.

This study aimed to compare the clinical outcomes and postoperative activities of arthroscopic ankle lateral ligament (ALL) repair alone with arthroscopic ALL repair and reinforcement by the inferior extensor retinaculum (IER) for chronic ankle instability (CAI). All patients who underwent arthroscopic repair for CAI between 2017 and 2019 were evaluated. The Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q), and duration between the surgery and walking without any support, jogging, and complete return to sports were evaluated and compared. The exclusion criteria were (1) follow-up period of < 1 year after surgery, (2) the presence of associated ankle lesions requiring treatment during the same operative procedure, including patients with subfibular ossicle bigger than 5 mm on radiographs, chondral or osteochondral defect, bony impingement, deltoid ligament tear, fibular tendon pathology, or posterior ankle impingement, and (3) patients who underwent revision surgery. We identified 126 patients who underwent surgery for CAI and subsequently excluded 36 patients on account of a short follow-up period (

Forefoot defects caused by accidents are very common, but their reconstruction remains a substantial challenge for plastic surgeons. The purpose of this study is to determine the anatomical structure of the first metatarsal proximal perforator-based flap and to propose its clinical application. The study was divided into two parts: an anatomical study and a clinical application. Thirty preserved lower limbs injected with red latex were chosen for observation, and the following were recorded: the course and distribution of the medialis dorsalis pedis cutaneous nerve; the origin, course, branching and distribution of the first metatarsal proximal perforator; and the communication of the perforator and the dorsal medial vessels. Clinically, six cases of forefoot skin defects were reconstructed with the first metatarsal proximal perforator-based neurocutaneous vascular flap. The medialis dorsalis pedis cutaneous nerve mainly arose from the medial branch of the superficial peroneal nerve and proceeded forward for a distance of 2.5 ± 0.4 cm under the surface of the inferior extensor retinaculum; then, the nerve divided into the medial dorsal branch and the first and second dorsal metatarsal branches. The first metatarsal proximal perforator-based neurocutaneous vessels were multisegmented and multisourced, and the first branch was closely related to the operative procedure. In terms of the clinical application, all flaps of the six cases survived completely with good appearance, texture and elasticity. The first metatarsal proximal perforators present as constant. The first metatarsal proximal perforator-based neurocutaneous vascular flap may become a useful supplemental material for the reconstruction of forefoot defects. Clin. Anat., 33:653-660, 2020. © 2019 Wiley Periodicals, Inc.

Category: Sports; Arthroscopy Introduction/Purpose: Though several arthroscopic surgical techniques for the treatment of lateral instability of the ankle have been introduced recently; the effect for the inferior extensor retinaculum augmentation is remained unclear. The purpose of this study was to compare the clinical outcomes after arthroscopic anterior talofibular ligament (ATFL) repair with or without additional retinaculum augmentation. Methods: We performed a retrospective review between 2017 and 2018 of 61 consecutive patients who underwent arthroscopic ATFL repair surgery for chronic ankle lateral instability. The exclusion criteria were previous surgery on affected ankle and combined medial ligament instability. Demographic data were evaluated including age, gender, smoking, Body mass index, generalized hyperlaxity and concomitant lesions. Patients were divided into two groups according to whether retinaculum repair or not. Clinical results were analysed to compare groups A and R preoperatively and at minimum follow-up of 1 years by using the Visual Analogue Scale, American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome score (FAOS), and Karlsson Ankle Functional Score. Radiologic outcome evaluations were performed preoperatively and at 2 year postoperatively at final follow-up using anterior talar translation, and talar tilt angle. Results: A total of 62 patients were included in this study. Patients were divided into two groups: group A consisted of 29 patients who underwent only arthroscopic ATFL repair and group R consisted of 32 patients who underwent arthroscopic ATFL repair and additional retinaculum augmentation. There was no difference statistically between two group in demographics (Table 1). All clinical scores were improved after surgery in both groups. (PConclusion: Arthroscopic ATFL repair achieved improved outcomes postoperatively with or without retinaculum augmentation. However, among physically active patients with chronic ankle lateral instability, arthroscopic ATFL repair with retinaculum augmentation results in better sports activity unit in FAOS as compare with arthroscopic ATFL repair alone.

Although several arthroscopic procedures for lateral ligament instability of the ankle have been reported recently, it is difficult to augment the reconstruction by arthroscopically tightening the inferior extensor retinaculum. There is also concern that when using the inferior extensor retinaculum, this is not strictly an anatomical repair since its calcaneal attachment is different to that of the calcaneofibular ligament. If a ligament repair is completed firmly, it is unnecessary to add argumentation with inferior extensor retinaculum. The authors describe a simplified technique, repair of the lateral ligament alone using a lasso-loop stitch, which avoids additionally tighten the inferior extensor retinaculum. In this paper, it is described an arthroscopic anterior talofibular ligament repair using lasso-loop stitch alone for lateral instability of the ankle that is likely safe for patients and minimal invasive. Level of evidence Therapeutic study, Level V.

Anterior ankle snapping syndrome is rare. Snapping of the extensor digitorum longus due to attenuated inferior extensor retinaculum and snapping due to hypertrophied or low-lying peroneal tertius muscle have been reported. We reported a new mechanism of anterolateral snapping due to a hypertrophied talar head. Anterolateral snapping ankle can be revealed by active dorsiflexion and plantarflexion of the ankle with the foot inverted. Foot inversion will tension the inferior extensor retinaculum and uncover the dorsolateral prominence of the talar head. The dorsolateral prominence of the talar head will snap over the proximal edge of the inferior extensor retinaculum. This technical note reports the technique of arthroscopic contouring of the talar head via extra-articular ankle arthroscopy. We named this technique arthroscopic taloplasty.

Chronic lateral ankle instability causes significant problems with physical activity. The purpose of the present study was to evaluate the results of ligamentous retensioning combined with reinforcement using an extensor retinaculum flap. A consecutive series of 38 patients were included with a minimum follow-up duration of 2 years. The functional results were assessed using the Karlsson and American Orthopaedic Foot and Ankle Society scale scores. The pre- and postoperative radiologic assessment was performed using stress radiographs to measure varus tilt and anterior drawer tests. All 38 patients were followed up for 2.5 to 7.2 years, and 35 patients were satisfied. The American Orthopaedic Foot and Ankle Society scale score had improved significantly from 57 (range 20 to 70) points preoperatively to 95 (range 80 to 100) points postoperatively (p < .0001), and 35 patients believed their ankle was more stable after surgery. The patients had returned to their previous sports activities an average of 4.7 (range 2 to 12) months after surgery. On the stress radiographs, the mean talar tilt angle had improved significantly from 15.2° (range 6° to 26°) preoperatively to 3.8° (range 1° to 8°) at the final follow-up visit (p < .001), and the mean anterior talar had improved significantly from 13.2 (range 8 to 18) mm preoperatively to 4 (range 4 to 7) mm at the final follow-up visit (p < .002). Regarding the prognostic factors, a link was found between the functional result and residual radiologic laxity measured on the stress radiographs. Reconstruction of the lateral ligaments for chronic ankle instability combining capsuloligamentous retensioning and reinforcement with an extensor retinaculum flap resulted in successful outcomes, excellent ankle stability, and preservation of ankle joint mobility. This technique addressed both lateral ankle and subtalar instability by developing an extraarticular interosseous ligament.

The inferior extensor retinaculum (IER) is an aponeurotic structure, which is in continuation with the anterior part of the sural fascia. The IER has often been used to augment the reconstruction of the lateral ankle ligaments, for instance in the Broström-Gould procedure, with good outcomes reported. However, its anatomy has not been described in detail and only a few studies are available on this structure. The presence of a non-constant oblique supero-lateral band appears to be important. This structure defines whether the augmentation of the lateral ankle ligaments reconstruction is performed using true IER or only the anterior part of the sural fascia. It is concluded that the use of this structure will have an impact on the resulting ankle stability.

Closed subcutaneous rupture of the extensor digitorum longus tendon (EDL) has been rarely documented. We present a case report of a patient with closed subcutaneous rupture of EDL. To identify the site of tendon rupture, three-dimensional computed tomography (3D-CT) was performed. The 3D-CT (volume rendering) images indicated tendon rupture of EDL on the dorsal region of the left foot. To identify the mechanisms of EDL rupture we also performed a biomechanical study using three cadavers. The patient granted permission for submission of personal data for publication. From biomechanical findings, pressure of the EDL on the inferior extensor retinaculum was 4.9–10.7 times higher in plantar flexion than in dorsal flexion of the ankle. Therefore, we believe that EDL rupture occurred with a passive flexion force pressing onto the toe tip in the plantar flexion position of the ankle joint.

We have treated 12 patients with chronic ankle instability using a modified Blanchet ligamentoplasty. The lateral ligaments were shortened and reinforced with an inferior extensor retinaculum flap. All 12 patients had functional instability and were assessed with preoperative stress X-rays. Follow-up averaged 19 months. A subjective grading scale was used to classify the results. Postoperative stress radiographs were also taken. There were 9 excellent results, 2 good results, 1 fair result and no poor result. Overall, 11 had an excellent or good result. There were no complications.

The aim of this study was to assess the results of 32 cases of chronic ankle instability. These were treated by ligament shortening and reinforced with an inferior extensor retinaculum flap. All patients complained of persistent functional instability unrelieved with proprioceptive exercises. Results were assessed clinically (pain, instability, recovery of sports activity, mobility) and radiologically (correction of laxity on stress x-rays). This enabled us to draw up a revision score on a scale of 100 points. We obtained a mean score of 86.7 points (45–100 points), and subjective results showed that 88% of the patients were satisfied with the surgery.

Background: 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. Methods: 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. Results: 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. Conclusion: 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. Clinical Relevance: The anatomical description provided here may provide a more accurate theoretical foundation for clinical subtalar stability restoration.

We have treated 45 patients (47 ankles) for chronic lateral instability by a new reconstructive procedure. The operation includes lateral shift of the entire lateral capsule-ligament complex and proximal advancement of the talocalcaneal ligament and the inferior extensor retinaculum. We reviewed 39 patients (39 ankles) at a mean of 4.6 years (2 to 7) after operation. There were 29 men and 10 women with an average age of 27 years (19 to 43); 11 of them were competitive college-level athletes and 28 were recreational athletes. The functional rating was excellent in 26 patients, good in 8, fair in 3 and poor in 2. Thirty-six patients (92%) were satisfied with the result and 34 (9 of 11 college-level athletes and 25 of 28 recreational athletes) have been able to return to their preinjury level of sport. At the last review, there had been only three episodes of recurrent ankle instability, all in recreational athletes; none had required further surgery. The unsatisfactory results were associated with pre-existing degenerative changes in the ankle.

Level of Evidence: V, Expert Opinion

Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the inferior extensor retinaculum of the ankle. We report a patient with anterior tarsal tunnel syndrome who was successfully treated with endoscopic anterior tarsal tunnel release. Our endoscopic technique, because it preserves the inferior extensor retinaculum, is potentially less traumatic than traditional surgical techniques for repairing this entrapment neuropathy.

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.

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.

A review of the ligamentous structures spanning the subtalar joint laterally, as well as within the sinus and canalis tarsi, is presented based on previous descriptions and a series of anatomic dissections. Defined supporting structures are categorized into superficial, intermediate, and deep layers. Of these, the inferior extensor retinaculum is seen to be a discrete, substantial structure readily accessible for ligament reconstructions involving both the ankle and subtalar joints.

The diagnosis of subtalar instability remains difficult both clinically and radiographically. The authors present an anatomic and MRI study of the subtalar ligamentous support. The anatomic study has consisted in dissections and sections of cryoconserved hindfeet (15 cases) which precises the organisation of ligamentous bundles in the lateral (sinus tarsi) and central (canalis tarsi) subtalar compartments, mainly represented by the trilayered inferior extensor retinaculum, the cervical talo-calcaneal ligament and the interosseous talo-calcaneal ligament. MRI study (1.5 tesla) of anatomic specimens was performed according to defined types of sections: sagittal, coronal, coronal oblique, axial transverse. The correlations of anatomic and MRI sections allowed a precise interpretation of the subtalar ligamentous support as anatomically described. A complementary clinical MRI study was performed which allowed the validation of “the inversion test”: this test optimizes the visualization of the different ligamentous structures. Relative to the difficulties of conventional imaging procedures, MRI appears of clinical relevance in the diagnosis of subtalar instabilities. This technique allows direct visualization of ligaments (or their rupture) and therefore a better evaluation of subtalar involvement in ankle sprain. This paper present a functional concept in MRI articular ligamentous restraints concern.

Summary A superficial dorsalis pedis artery was found in two (0.7%) of 296 Japanese feet. The sciatic and saphenous arteries were not present. This artery arose from the anterior tibial artery at the ankle, penetrated the inferior extensor retinaculum and ran forward over the deep fascia of the foot. The artery gave off a superficial dorsal metatarsal artery and continued into the deep plantar branch perforating the first dorsal interosseous muscle. In the second case, a thin deep dorsalis pedis artery anastomosed with the superficial dorsalis pedis artery to form an arterial circle surrounding the tendons of the extensor hallucis muscles. In man, the saphenous artery usually degenerates and therefore the superficial dorsalis pedis artery has not hitherto been recorded. The origin of this artery is considered to be a remnant of the distal part of the saphenous artery or an enlarged by-pass supplying the cutaneous nerves and subcutaneous tissue.

The anterior tarsal tunnel syndrome, described by Marinacci in 1968, is an entrapment neuropathy of the deep branch of the peroneal nerve beneath the inferior extensor retinaculum. Five cases of this syndrome are presented. The patients have complained pain or paresthesia in front of the ankle or dorsum of the foot. Hypaesthesia and hypoalgesia were found in sensory area of the deep peroneal nerve which was distinctly sensitive to pressure under the inferior extensor retinaculum. It is necessary to take care in making examinations on a patient who shows symptoms on the same place so as to avoid misdiagnosis and useless diagnostic procedures and treatment.

The ligaments of the tarsal sinus and canal, including the roots of the inferior extensor retinaculum, the cervical ligament and the ligament of the tarsal canal, have been restudied and their function has been correlated with the movements of inversion and eversion. The ligaments are extracapsular and their attachments are somewhat more complex than previously reported. A band of fibers, heretofore undescribed, has been designated as the “oblique talocalcaneal band.” It passes from the calcaneal attachment of the intermediate root of the inferior extensor retinaculum to join the talar attachment of the ligament of the tarsal canal. The ligament of the tarsal canal averages 5.6 mm in width and 1.6 mm in thickness compared with the cervical ligament which is 11.6 mm wide and 2.8 mm thick. The axis of talocalcaneal movement passes between the articular surfaces of the talocalcaneonavicular and subtalar joints and, as a consequence, these articulations move in directions opposite to one another in inversion and eversion. Direct observation during passive movement indicates that the cervical ligament limits inversion whereas the ligament of the tarsal canal plays little or no role in limiting either inversion or eversion. The ligament of the tarsal canal appears to maintain apposition of the talus and calcaneus in all positions.