| Doctors are unlikely to pay attention to the ligaments injury of the foot with no fracture in clinical, because doctors themselves have a lack of understanding about the anatomy and functions of the ligaments. If the injuries were not treated properly, the pain maybe appearance, severe cases maybe show continued pain or even deformity. Athletes and sports-loving people have a high risk of the disease. People who got fracture or dislocation of the foot always have ligaments injury. In order to make an accurate diagnosis and treatment, reduce mistreatment and wrong treatment, it is necessary to know the anatomy and functions of the ligaments of the foot. However, the description or introduction of the ligaments was little in anatomic books, even there was some errors in the pictures. Based on this, we did a study in cadavers for a detailed observation about the ligaments of the foot,and explored the functions of the ligaments, for the purpose of providing some anatomical information to the doctor.Part I Ligaments of the Foot:An Anatomic Observation in CadaversMaterials and MethodsThirteen embalmed human legs (six right and seven left) from eleven cadavers and two feet from one fresh cadaver donated for anatomical training were examined. The ages of the cadavers were unknown. No specimen had any apparent deformity on gross examination. The specimens were dissected by an orthopedic surgeon. Remove the skin, fat, muscle, blood vessels, nerves and other tissues to expose the dorsal and plantar ligaments, and then remove the plantar ligaments to expose the interosseous ligaments.The gross anatomy and the morphological characteristics of the ligaments were recorded.ResultsLigaments of the foot can be divided into three groups according to the position:the dorsal,interosseous and plantar ligaments.Dorsal ligamentsIn addition to the bifurcate ligament, the dorsal ligaments were flat and thin. Each of them connected the adjacent bones. The dorsal ligaments were transverse, longitudinal or oblique in the dorsal of the foot. There was no ligament between the base of the first and second metatarsal. Dorsal ligaments of the footinclude:①talonavicular ligament,②cervical ligament,③dorsolateral calcaneocuboid ligament,④dorsal cuboideonavicular ligament,⑤dorsal cuneonavicular ligament,⑥lateral calcaneonavicular ligament,⑦The medial calcaneocuboid ligament,⑧dorsal ligaments of the tarsometatarsal,⑨dorsal ligaments of the metatarsal.Plantar ligamentsThe plantar ligaments had different morphology. They were large and strong. The spring ligament, the long and short plantar ligament and the cuneonavicular ligament nearly covered the entire plantar of the foot, which formed a triangle structure in the plantar of the foot. Sometimes, the same ligament in different specimens has some differences in morphology. Plantar ligaments of the foot include:①plantar calcaneocuboid ligament,②superomedial calcaneonavicular ligament,③medioplantar oblique calcaneonavicular ligament,④inferoplantar longitudinal calcaneonavicular ligament,⑤medial bundle of Plantar cuneonavicular ligament,⑥intermediate bundle of Plantar cuneonavicular ligament,⑦lateral bundle of Plantar cuneonavicular ligament,⑧plantar cuboideonavicular ligament,⑨the plantar Lisfranc ligament.Interosseous ligamentsThe number of the interosseous ligaments was large, most of them were transverse and had the similar shape, but the length and thickness were different.There was no interosseous ligament between the calcaneus and the cuboid, the talus and the navicular, the navicular and the cuneiforms. Lisfranc ligament was an oblique ligament that arose from the lateral surface of the medial cuneiform bone, attached to the lower half of the medial aspect of the second metatarsal. In addition, we found several ligaments arose from the lateral surface of the lateral cuneiform bone attached to the lateral surface of the third metatarsal and to the medial surface of the fourth metatarsal. There was interosseous ligaments between the bases of the metatarsal bones except the first metatarsal bone.Part Ⅱ Ligaments of the Foot:An Observation and analysis in MR imageMaterials and MethodsWe selected10cases of volunteers,7were male,3were female, age from21to54years old, the feet of the volunteers had no deformity, without trauma and operation history, eliminate the disease like rheumatoid arthritis, gout, diabetes, which may affect the outcome. Choose GM1.5T superconducting magnetic resonance scanner. Axial, sagittal and coronal planes MRI scans of volunteers was be made. Sagittal and axial plane was parallel to the long axis of the foot when scanning, while coronal plane was vertical to the long axis of the foot when scanning. Select T1WI and T2WI scanning sequence. The visualization of the ligaments in MR image of20feet were assessed, and the effect of image display was analyzed with a5Scores, in order to compare the two kinds of MRI sequences on display the degree of the foot ligaments. Use Mann-Whitney U Test, there was statistical significance when P>0.05.ResultsT1WI sequence and T2WI sequence can display foot ligaments very well, with a low signal in MR image. The same ligament has different appearance in different plane. Some dorsal ligaments and interosseous ligaments were thin and short, they were difficult to be seen in MR image。Dorsal ligaments has a good display in the sagittal and coronal plane, they were hard to see in axial plane. Because of the dorsal tarsometatarsal ligaments and the dorsal metatarsal ligaments were thin, MRI was difficult to display. In the interosseous ligaments, the interosseous talocalcaneal ligament and Lisfranc ligament can be seen on the three plane, the interosseous talocalcaneal ligament can be better seen in sagittal and coronal plane, Lisfranc ligament was display better in axial plane. The rest of the interosseous ligaments can be showed on coronal and axial planes, but because these ligaments are numerous and short, it is difficult to identify each ligament in MR images. Plantar ligaments has a good display in the sagittal plane because of their anatomical features, followed by the coronal plane and the axial plane. MRI is a anatomical image of one aspect of the foot, so, it could not be observed the differences morphological of the ligament between different individuals. The best MR scanning range is consistent with the gross anatomy ligament walking.The score of dorsal ligaments in sagittal plane of the T1WI were0case with0score,0case with1score,1cases with2score,9cases with3score,0case with4score respectly. The score in coronal plane were0case with0score,2cases with1score,8cases with2score,0case with3score,0case with4score respectly. The score in axial plane were9cases with0score,1cases with1score,0case with2score,0case with3score,0case with4score respectly. The score of dorsal ligaments in sagittal plane of the T2WI were0case with0score,0case with1score, 2cases with2score,8cases with3score,0case with4score respectly. The score in coronal plane were0case with0score,3cases with1score,7cases with2score,0case with3score,0case with4score respectly. The score in axial plane were9cases with0score,1cases with1score,0case with2score,0case with3score,0case with4score respectly. After Mann-Whitney U Test,there was not statistically significant (P>0.05), it may be considered that T1WI and T2WI had no difference on display dorsal ligament of the foot.The score of plantar ligaments in sagittal plane of the T1WI were0case with0score,0case with1score,1cases with2score,9cases with3score,0case with4score respectly. The score in coronal plane were0case with0score,2cases with1score,8cases with2score,0case with3score,0case with4score respectly. The score in axial plane were0case with0score,0cases with1score,7cases with2score,3cases with3score,0case with4score respectly. The score of plantar ligaments in sagittal plane of the T2WI were0case with0score,0case with1score,2cases with2score,8cases with3score,0case with4score respectly. The score in coronal plane were0case with0score,2cases with1score,8cases with2score,0case with3score,0case with4score respectly. The score in axial plane were0case with0score,0cases with1score,8cases with2score,2cases with3score,0case with4score respectly. After Mann-Whitney U Test,there was not statistically significant (P>0.05), it may be considered that T1WI and T2WI had no difference on display plantar ligament of the foot.The score of interosseous ligaments in sagittal plane of the T1WI were0case with0score,8cases with1score,2cases with2score,0case with3score,0case with4score respectly. The score in coronal plane were0case with0score,2cases with1score,8cases with2score,0case with3score,0case with4score respectly. The score in axial plane were0case with0score,5cases with1score,5cases with2score,0case with3score,0case with4score respectly. The score of interosseous ligaments in sagittal plane of the T2WI were0case with0score,8cases with1score,2cases with2score,0case with3score,0case with4score respectly. The score in coronal plane were0case with0score,3cases with1score,7cases with2score,0case with3score,0case with4score respectly. The score in axial plane were0case with0score,6cases with1score,4cases with2score,0case with3score,0case with4score respectly. After Mann-Whitney U Test,there was not statistically significant (P>0.05), it may be considered that T1WI and T2WI had no difference on display interosseous ligaments of the foot. Although the T1WI and T2WI display the ligaments of the foot have no difference on statistically, but the clarity of T1WI was superior to T2WI.Conclusion1, The number of the ligaments of the foot is large and the distribution is broad. They are one of the most important stabilizers to the arch of the foot. Dorsal, interosseous and plantar ligaments have their own anatomical characteristics, which reflect their different functions in maintaining the arch of the foot.2, Most of the foot ligaments can be observed in MR image. But some dorsal ligaments and interosseous ligaments were thin and short, they were difficult to be seen in MR image. Because MRI is an anatomical image of a certain section, it could not be observed the differences of the ligaments in morphology between different individuals.3, It is very important to choose a suitable scanning range and sequence for the ligaments in order to obtain a complete and clear observation. In general, when MRI section consisted with the ligament walking,a completely, fully displayed the anatomic characteristics of ligament can be seen on MR image, which is better for getting an accurate, complete observation and evaluation of the ligament. |
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