Ultrasound imaging and Fascial Manipulation?: 'Adding a twist' on the ankle retinacula

Background: Retinacula of the ankle are thickening of the deep fascia of the leg (crural fascia) and foot i.e. inseparable structures. Recent studies report their crucial role in functional stability and proprioception of the ankle. Case presentation: A 38-yr-old Caucasian man -with a history of lateral malleolus fracture 12 years ago, obesity and right ankle osteoarthritis -was referred to a physiatrist for a right ankle pain that had significantly worsened over the last year. During walking, the patient experienced stinging pain in the area of tibialis anterior and peroneus tertius muscles, and the superior extensor retinaculum. Magnetic resonance imaging and ultrasonog-raphy showed clear thicknening (2.05 mm) of the oblique superomedial band of the inferior extensor retinac-ulum. Sonopalpation was performed to precisely evaluate/confirm the site of maximum pain. Foot function index (FFI) score was 42. Results: Subsequently, the patient was prescribed fascial manipulation, and he had clinical improvement after the first session (FFI: 21). At 1-month follow-up, the patient was still asymptomatic without any functional limitation (FFI: 24). US imaging confirmed the decreased thickness of the oblique superomedial band of the extensor retinaculum (1.35 mm). Conclusion: Fascial Manipulation (R) appears to be a useful tool to reduce thickness, stiffness, and pain in this case as displayed by the ultrasound Imaging.