Fascia of the limbs ‐ histological and biomechanical considerations

The lecture will commence with a general overview of the structure and functional significance fascia in both the upper and lower limbs and the importance of fascial planes in the limbs in relation to the spread of infection. Considerable emphasis will be placed on the work of Professor Frederic Wood Jones and in particular to his concept of a fascial ‘ectoskeleton’. The widespread role of fascia in dissipating stress concentration away from entheses (tendon/ligament attachment sites) will be a key aspect of the first half of the talk. Subsequent attention will be focussed on selected fascias of particular interest to the author ‐ including retinacula, the fascia lata and the plantar fascia. The intimate association of retinacula with wrap‐around tendons and their bony pulleys will be reviewed in relation to the concept of a ‘functional enthesis’ in order to explain the potential for fibrocartilage differentiation within fascia. In dealing with the fascia lata, the anatomical basis underpinning the hypothesis that iliotibial band syndrome is an overuse injury that can be better attributed to compression rather than to friction will be presented. Finally, in reviewing the plantar fascia, emphasis will be placed on its relationship to the Achilles tendon and to the heel fat pad and to its association with bony spurs and heel pain.