Anatomical variations of peroneal muscles: a cadaver study in an Indian population and a review of the literature. Orthopaedics, anatomists and radiologists should be aware of this accessory tendon structure because of its clinical importance. Communication among these physician specialties is crucial. The authors could find only one previous case report for alternate peroneus brevis tendon insertion on the calcaneus which was discovered during surgical exploration. Just back in paper a long time ago, Don Beck in a publication in 2003 that he showed that only 60% of 40 peroneal tendon disorders . Furthermore, the imaging examinations, especially dynamic ultrasound, validated the presence of the PQ within the sheath, not as a tendon, but rather as a plump muscle tissue reducing the available space for the peroneal tendons. Absence of lateral ankle edema and peroneal tenosynovitis should raise suspicion for variant tendon insertion. Peroneus brevis, peroneal tubercle, peroneal variant, peroneus quartus, peroneal tendon tear, 24 year old male with variant peroneus brevis tendon insertion on the calcaneus. J Bone Joint Surg Am 73-A:131133, Trono M, Tueche S, Quintart C, Libotte M, Baillon JM (1999) Peroneus quartus muscle: a case report and review of the literature. Federal government websites often end in .gov or .mil. 8600 Rockville Pike Skeletal Radiol. Proc R Soc Lond 16:483525, Pozzi S (1872) Sur une vari_et_e fr_equente du muscle court p_eronier lateral chez lhomme (anomalie reversive). Endoscopic Resection of Peroneus Quartus. There are very few publications regarding the association of supernumerary PQ muscle and FAI. Diagnosis is made clinically with subfibular ankle pain with the sensation of apprehension or subluxation with active dorsiflexion and eversion against resistance. Immobilization can include cast or controlled ankle motion boot. then Oznur et al. It seems also relevant to establish a diagnosis as early as possible to avoid lesions of the ligaments resulting from recurrent ankle sprains that will then foster this chronic instability. There are three primary disorders of the tendons; Peroneal tendonitis, peroneal subluxation, and peroneal tendon tears. It can be symptomatic and associated with splits or tears in the peroneus brevis, subluxation or dislocation of the peroneal tendon, tendinous calcification, chronic peroneal compartment syndrome, and painful hypertrophy of the retrotrochlear eminence. The presence of the following soft-tissue and osseous variants and abnormal conditions within the peroneal tunnel were also recorded: peroneal tendon subluxation or dislocation, torn peroneal tendons, peroneus quartus muscle, lateral collateral ligament injury, and abnormal shape of the fibular groove [ 6 - 8 ]. bifid peroneus brevis and peroneus quartus tendons), which may also appear as "extra" tendinous bands within the peroneal tendon sheath. Other less common insertions were described such as the tendon of the peroneus brevis or longus, the cuboid, the base of the fifth metatarsal or the superior peroneal retinaculum. MR imaging of the accessory muscles around the ankle. a b c d Supramalleolar level: peroneus quartus muscle and tendon ( ) are visible posteromedially to PB and PL tendons. Cheung YY, Rosenberg ZS, Ramsinghani R, Beltran J, Jahss MH. It is related to many pathologic conditions in the lateral ankle compartment but also it can be used as a tendon graft for reconstructive procedures. After tendon tear repair surgery, complications are re-tear and continued symptoms, shown to occur in about 10% of patients by Dombek.[7]. We describe a 51-year-old woman with a longitudinal split tear of the peroneus brevis tendon confirmed by magnetic resonance imaging. Steinbck G, Pinsger M. Treatment of peroneal tendon dislocation by transposition under the calcaneofibular ligament. After all conservative treatments failed, the surgical explorations validated the presence of supernumerary PQ muscles and after surgical resections all symptoms disappeared. What is Quartus used for? In 17 legs (63%) the muscle originated from the muscular portion of the peroneus brevis, and inserted on the peroneal tubercle of the calcaneus. Avulsion fracture of the fifth metatarsal or fibular groove should entail fixation or repair. Potential targets for future research could include variant tendon insertion association with chronic lateral ankle instability or predisposition for acute or chronic tendon tears. TECHNIQUE: Siemens Verio 3T, coronal proton density sequence without injected contrast (TR 3850, TE 36, 3mm slice thickness/spacing). Additionally, a pharmacist may be necessary to verify medication reconciliation if the decision is made to institute NSAID or other pain management pharmacotherapy. Cerrato RA, Myerson MS. Peroneal tendon tears, surgical management and its complications. A normal peroneus longus tendon with magic angle artifact (long arrow) is also annotated. Quartus Prime maintains the look and feel of Quartus II, but it has a whole new infrastructure under the hood - specifically designed to handle the monster designs that will be thrown at the company's "Generation 10" FPGAs. 20 year old male with variant peroneus brevis tendon insertion on the calcaneus. The pain was characterized as radiating from the ankle to the base of the fifth metatarsal. In this patient, it seems that the bilateral ankle instability is caused by several factors. Radiology 242:509517, Athavale SA, Gupta V, Kotgirwar S, Singh V (2012) The peroneus quartus muscle: clinical correlation with evolutionary importance. (c) An end-to-side transfer of the peroneus longus tendon to the peroneus brevis tendon was performed. Foot Ankle 10:4547, Mick CA, Lynch F (1987) Reconstruction of the peroneal retinaculum using peroneus quartus: a case report. Describe interprofessional team strategies for improving care coordination and communication to advance peroneal tendon syndromes and improve outcomes. The authors retrospectively reviewed the images from 200 consecutive ankle MRI examinations performed between May 2012 and March 2013. Most patients will require some type of rehabilitation to regain muscle function and strength. It should also be noted that variant tendon insertion on the calcaneus potential confounds dynamic evaluation of peroneus brevis tendon with ultrasound. Cest un symptme fonctionnel subjectif diffrencier de la laxit qui est un signe dexamen clinique objectif. We are experimenting with display styles that make it easier to read articles in PMC. a: transversal view of the lateral retromalleolar (LM: lateral malleolus) showing the muscle body of the peroneus quartus (PQ) within the sheath of the peroneus brevis and longus muscles (PB and PL). Insertion on the peroneal tubercle has also been reported [7]. The peroneus quartus muscle, with a number of different attachments, was present in 5.2% (6/115) of the legs. Furthermore, most authors reported a male predominance (2.5/1 for Saupe et al. It's a tendon that crosses two articulations that begins at the superolateral condylar bridge of the knee and extends distally to the middle aspect of the calcaneus. The Quartus II software includes solutions for all phases of FPGA and CPLD design (Figure 1). There are three primary disorders of the tendons; peroneal tendonitis, peroneal subluxation, and peroneal tendon tears; these conditions are a cause of lateral ankle pain and may lead to ankle instability. Epub 2014 Feb 14. PMC In one review of 82 patients with chronic lateral ankle instability, MRI sensitivity and specificity of peroneal tendinopathy were reported as 83.9% and 74.5%, respectively [11]. All of the three patients received open peroneal tendon repair with groove tubular deepening for the 1 st patient. government site. Saupe N, Mengiardi B, Pfirrmann CW, et al. These symptoms can spontaneously appear but usually they are triggered by acute trauma such as lateral ankle sprain. The sensitivity is 83%, and specificity is 75% for peroneus brevis tears. The electroneuromyogram of the peroneus muscles was normal. L'objectif de ce cas clinique est de discuter l'imputabilit de la prsence d'un quatrime fibulaire bilatral, chez un patient souffrant d'instabilit chronique. Peroneal tendon disorders are common causes of lateral and retromalleolar ankle pain. The most common mechanism is a dorsiflexed foot with . Anat Sci Int 83(4):280282, Sobel M, Levy ME, Bohne WH (1990) Congenital variations of the peroneus quartus muscle: an anatomic study. We also defined a new type of peroneus quartus with a bifurcated insertion around the peroneus brevis. TECHNIQUE: Siemens Verio 3T, axial proton density sequence without injected contrast (TR 4830, TE 35, 4mm slice thickness/spacing). 4 , 17 It is rarely involved in pathologic processes of the . If this does not provide any improvement steroid injection around the peroneal tendon sheath can help with pain as well as assist with diagnosis. The fact that symptoms appear during an effort could be explained by the phenomenon of muscle swelling worsening the conflict and thus leading to a real lateral ankle stenosis syndrome by overcrowding effect. However no neurological impairment was detected during the electroneuromyogram. Retromalleolar pain was revealed in all of the patients, in addition to instability. On the MR scans its presence was associated with pain and weakness of the ankle. 1,31 The PCI muscle originates along the inner part of the lower third of the fibula. Peroneal tendon disorders are a cause of hindfoot and lateral foot pain. Sobel et al. CPT 28200 is for repair of tendon. They run in a tunnel bordered by the superior peroneal retinaculum, the posterior fibula that has a retromalleolar groove, and the calcaneofibular ligament. However, return to sporting activity should not be rushed, and the orthopedic surgeon should see the patient for clearance. Bone block procedures that involve performing osteotomy of the fibula lateralizing it to create a bony block for the tendons. Saxena A, Ewen B. Peroneal subluxation: surgical results in 31 athletic patients. Epub 2019 Feb 6. However its symptomatic clinical presentation seems quite rare and harder to demonstrate. We can see the peroneal tendons as they glide down the lateral aspect of the ankle, secured in place by the superior peroneal retinaculum. [9], Ultrasound is a no radiation, inexpensive imaging modality that can provide an evaluation of the tendon in motion, as well as assist with injections. [11], MRI is the next step in evaluation with a high-quality view of the tendons with no exposure to radiation. In these cases, peroneal sheath tenosynovitis is usually present on MRI. FINDINGS: AP and lateral radiographs of the right ankle show no osseous or soft tissue abnormalities. X-rays should be weight-bearing and include standard AP, mortise, and lateral ankle views. The peroneal tubercle was hypertrophied at the insertion in most cases. Radiology 202:745750, Wood J (1866) Variations in human myology observed during the winter session of 18651866 at Kings College London. On observe ensuite lors de la phase dappui un passage en valgus bilatral. Lincidence de ce muscle varie selon les sries de 0 21,7 %. Associated pathologies are longitudinal degeneration and tear in the tendon of peroneus brevis. There are several variations of this accessory muscle, and its terminology is very confusing. Imaging demonstrated insertion of the peroneus brevis tendon on the calcaneal peroneal tubercle with absence of the tendon distal to the calcaneus. Also, the peroneus longus will plantarflex the first ray leading to hindfoot varus during walking. Radiology 218:415419, Borne J, Fantino O, Besse JL, Clouet P, Tran Minh V (2002) Aspect IRM des variantes anatomiques des muscles, tendons et ligaments de la cheville. [Updated 2022 May 29]. Foot Ankle 11:8189, Prakash, Narayanswamy C, Singh DK, Rajini T, Venkatiah J, Singh G (2011) Anatomical variations of peroneal muscles: a cadaver study in an Indian population and a review of the literature. Peroneus brevis tendon tearsare acute or chronic, and may be asymptomatic or associated with lateral ankle pain and/or instability. Palpation of the tendons during ROM of the ankle. VHDL and Verilog are considered general-purpose digital design languages, while SystemVerilog represents an enhanced version of Verilog . Peroneus quartus: prevalance and clinical importance. Having pre-existing varus hindfoot alignment can increase strain on the peroneus longus tendon that can lead to inflammation, subluxation, and possible tears. Mustafa Gkhan Bilgili. It is absent at the base of the fifth metatarsal (figures 224). Beobachtungen aus der Menschlichen und Vergleichenden Anatomie H VII:3580, Chaney DM, Lee, Khan MA, KruegerWA, Mandracchia VJ, Yoho RM (1996) Study of ten anatomical variants of the foot and ankle. Annals of Physical and Rehabilitation Medicine Volume 54 Issue 5. Variant congenital insertion of the peroneus brevis tendon on the calcaneus peroneal tubercle instead of its normal position on the lateral base of fifth metatarsal may occur in up to 1% of the population. The peroneus brevis tendon was absent at the base of the fifth metatarsal. Clarke HD, Kitaoka HB, Ehman RL. Archives of Orthopaedic and Trauma Surgery The peroneus quartus muscle fibers often arise from the peroneus brevis [8, 10]. Foot Ankle Int 21:462468, Cheung YY, Rosenberg ZS, Ramsinghani R, Beltran J, Jahss MH (1997) Peroneus quartus muscle: MRI imaging features. 20 year old male with variant peroneus brevis tendon insertion on the calcaneus. [Peroneal tendon pathologies : From the diagnosis to treatment]. The peroneus longus muscle and tendon: a review of its anatomy and pathology. Researchers have categorized AFM on the basis of origin and insertion as peroneus quartus [2,6, [8] [9] [10], peroneus accessorius [10], peroneus digiti minimi (quinti brevis) [2,8,10],. Associated pathologies are longitudinal degeneration and tear in the tendon of peroneus brevis. 89 Ban guna n penti ng T e n d 90 on Achilles Tendo dari M.Gastrocnemius dan M.Soleus adalah tendon paling tebal dan paling kuat di tubuh manusiapanjang 6 inchi, mulai tengah betis sampai bagian bawah, posterior calcus, dg bursa.achilles/achillis bisa putus pada gerakan lari, mendorong dan melompat dengan tiba-tiba The subject was a 20 year old male with diffuse right ankle pain following eversion injury. Magnetic resonance imaging (MRI) of the ankle was then obtained. Sympathetic blocks, nerve blocks and intrathecal drugs, Clinical practice guidelines for chronic neuropathic pain in the spinal cord injury patient: Introduction and methodology, Interest of rehabilitation in healing and preventing recurrence of ankle sprains, The winged scapula; a muscle rupture or a nerve paralysis? A normal peroneus longus tendon (long arrow) is also annotated. However some cases of chronic ankle pain or instability have been reported in the literature. He also described some bilateral retromalleolar pain triggered during instability incidents. The characteristic image finding for this variant is a peroneus brevis tendon which inserts on the lateral calcaneus on or near the peroneal tubercle. The site is secure. Matcuk GR Jr, Patel DB, Cen S, Heidari KS, Tan EW. Peroneus quartus, an accessory muscle in human: case report and its clinical importance. Learn more about Institutional subscriptions, Hecker P (1923) Study of the peroneus of the tarsus. Peroneal tendon disorders are a cause of hindfoot and lateral foot pain. In our patient, these phenomena could be worsened by the pes valgus planus disorder, reducing also the lateral retromalleolar space. It would be interesting to study these individuals further to discover if they are subject to higher rates of ankle instability or acute/chronic injuries of the peroneal tendons. . The degenerated part of the peroneus tendon was excised. [4] Chronic lateral ankle stability has also been shown to lead to subluxation and subsequent tears due to increased laxity and motion of the tendons. Lucas DE, Hyer CF, Berlet GC, Shockley JA. More rarely cases of an association with FAI were reported. Anat Sci Int 87:106110, Nascimento SRR, Costa RW, Ruiz CR, Wafae N (2012) Analysis on the incidence of the fibularis quartus muscle using magnetic resonance imaging. The objective of this clinical case is to discuss the impact of this supernumerary PQ muscle on functional ankle stability. J Foot Ankle Surg 52:118121, Article The peroneus quartus tendon (white arrow) is markedly thickened and oedematous compared with the previous study (Fig. The peroneus quartus is found with a frequency varying from 10 to 21.7% of observed individuals. A retrospective review of peroneal tendon tears showed brevis tears in 88% of patients, longus tears in 13% of patients and combined peroneus longus and brevis tears in 37%. Ultrasound diagnosis of peroneal tendon tears. However, there is new evidence that congenital variant insertion of the tendon on the calcaneal peroneal tubercle occurs in a small segment of the population. We report the case of a 26-year-old patient who consulted for recurrent episodes of lateral ankle sprains. 1. There is no peroneus brevis tendon distal to this level. MeSH Conclusion: It was suspected that the anatomical variant contributed to the patient's lateral ankle pain. The peroneus quartus is found with a frequency varying from 10 to 21.7% of observed individuals. Son origine est le plus souvent commune avec celle du muscle court fibulaire et sa terminaison trs variable: minence rtrotrochlaire du calcanum, tendon du long fibulaire, tubrosit du cubode pour ne citer que les plus frquentes. Coudert and Kouvalchouk presented two cases of female patients with painful FAI, at first evoking a recurrent dislocation of the peroneal tendons. Lobjectif de ce cas clinique est de discuter limputabilit de la prsence dun peroneus quartus bilatral sur linstabilit chronique de cheville. The peroneus quartus muscle, with a number of different attachments, was present in 5.2 % (6/115) of the legs. Our check-up also unveiled a supernumerary bilateral PQ muscle; its responsibility in our patients FAI should be discussed. No signs of tendon dislocation for the peroneus brevis muscles or tibialis posterior muscle. Please enable it to take advantage of the complete set of features! Additional imaging examinations showed a supernumerary bilateral peroneus quartus. Radiology. We dissected 102 cadaver legs and reviewed the magnetic resonance images of 80 patients with symptoms from the ankle. Davda K, Malhotra K, O'Donnell P, Singh D, Cullen N. Peroneal tendon disorders. An ultrasound of the ankles ( Fig. The peroneocalcaneal variant of the PQ muscle appears to insert in the retrotrochlear eminence of the calcaneus rather than the peroneal tubercle, contrary to previous reports. This activity outlines the presentation and treatment of peroneal tendon syndromes and offers a review of the current non-operative and operative treatment options. Its origins, insertions, and size varied. What does peroneal tendonitis feel like? What is the efficacy of regional interventions? Mentioning: 5 - This case report highlights a novel approach to strengthening the repair of a split peroneus brevis tendon tear with a peroneus quartus muscle autograft. This site needs JavaScript to work properly. Le plus souvent, ce muscle surnumraire est de dcouverte fortuite et nest responsable daucune symptomatologie. 1Department of Radiology, Mike OCallaghan Federal Medical Center, Nellis AFB, NV, USA, 2Department of Radiology, Landstuhl Regional Medical Center, Landstuhl, Germany. Il sagit de la complication volutive la plus frquente des entorses de cheville dont lincidence est estime jusqu 40 % selon les sries. [10], Peroneal tendonitis presents with gradual onset of pain and swelling. Different cases of patients with chronic pain and swelling around the ankle after lateral ankle sprain were studied by Moroney and Borton , White et al. Parmi les structures anatomiques impliques dans la stabilit de la cheville, les muscles fibulaires tiennent une place de choix. Overcrowding can with extra the muscle or tendon in the SPR and can lead to instability (4). In: StatPearls [Internet]. Image courtesy Dr Chaigasame, Peroneal tendon syndrome- Longitudinal split tear of the peroneus brevis tendon. Clipboard, Search History, and several other advanced features are temporarily unavailable. If x-rays indicate the possibility of fracture, peroneal tubercle, or retro trochlear eminence CT scan would be useful and determine possible management. Llectroneuromyogramme des muscles fibulaires est normal. belly or accessory muscle, such as a peroneus quartus. Finally, some examples of chronic dislocation of the peroneal tendons were mentioned . If the tendons chronically subluxate, this can lead to inflammation and irritation causing tendonitis. Peroneus quartus, a common variant muscle of the foot and ankle with many variations of origin and insertions, can lead to many pathologies such as peroneal tendinopathy, stenosis, tenosynovitis, tendon attrition and tears. This 26-year-old patient was seen in PM&R consultation for recurrent episodes of lateral ankle sprains. The rehabilitation training program specifically designed for our patient (e.g. HHS Vulnerability Disclosure, Help The peroneus quartus is a supernumerary muscle that has been well described in anatomical studies. [1]Tendon relationship at the level of the ankle is the peroneus brevis anterior and medial to the peroneus longus. Cependant quelques cas de douleurs chroniques de cheville, de luxation des tendons des fibulaires ou dinstabilit ont t rapports dans la littrature . J Am Podiatr Med Assoc 101(6):505508, Sammarco GJ, Brainard JB (1991) A symptomatic anomalous peroneus brevis in a high-jumper: a case report. A surgical consultation was scheduled to look at a possible resection of this supernumerary muscle. http://creativecommons.org/licenses/by/4.0/. FINDINGS: Contiguous sagittal proton density MRI images of the right ankle demonstrate the peroneus brevis tendon (short arrow) descending to its attachment on the calcaneal. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneus. The peroneal tendons are in the lateral compartment of the leg and include the peroneus longus and peroneus brevis muscles. J Bone Joint Surg Am 69-A:296297, Yong CK (2006) Peroneus quartus and peroneal tendoscopy. Brandes CB, Smith RW. The peroneal tubercle is not present in every individual, with sources reporting its presence in 40%55% of individuals [3, 4]. The authors declare that they have no conflicts of interest concerning this article. A common pertinent history finding is a description of snapping or popping at the lateral malleolus. 24 year old male with variant peroneus brevis tendon insertion on the calcaneus. These episodes started at the age of 17 following minor trauma or even no trauma at all. True split tears typically manifest with a "boomerang" appearance of the brevis tendon enveloping the longus tendon, and there is . After this first consultation we suggested a thorough check-up to refine the etiological diagnosis of this FAI. 1997 Mar;202(3):745-50. doi: 10.1148/radiology.202.3.9051029. De nombreuses variations anatomiques de ces tendons ont t dcrites responsables dans certains cas dune symptomatologie clinique et notamment dinstabilit . Finally, the term lateral ankle stenosis syndrome was first used by Donley and Leyes then again by Moroney and Borton , they described a prominent body of the PQ within the peroneal sheath reducing the available space for proper functioning of the peroneal tendons or even compressing them. The PQ is a supernumerary muscle of the distal lateral portion of the fibula. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneus. Thus an instable ankle is not necessarily due to hyperlax ligaments and conversely hyperlaxity of the ankle ligaments is not systematically responsible for FAI. Afterwards, various anatomical or imaging studies as well as a few clinical cases were published indicating that this muscle was responsible for various symptoms (e.g. The opinions expressed in this document are solely those of the authors and do not represent an endorsement by or the views of the United States Air Force, the Department of Defense, or the United States Government. Foot Ankle 13:413422, Article Clin Ter 163(4):307309, CAS A certain diagnosis can be established by magnetic resonance imaging (MRI) or surgery. There are three basic types of peroneal tendon disorders, tendonitis, subluxation, and tears. The peroneus brevis provides a small portion of the foots plantar flexion power and 28% of the hindfoot eversion power [1]. AJR Am J Roentgenol 168:141147, Chepuri NB, Jacobson JA, Fessell DP, Hayes CW (2001) Sonographic appearance of the peroneus quartus muscle: correlation with MR imaging appearance in seven patients. Wang XT, Rosenberg ZS, Mechlin MB, Schweitzer ME. He was also prescribed some custom-made orthopedic shoes, to compensate his bilateral pes valgus planus disorder. Prakash, Narayanswamy C, Singh DK, Rajini T, Venkatiah J, Singh G. J Am Podiatr Med Assoc. A surgical correlation. What is Quartus II used for? TECHNIQUE: Siemens Verio 3T, coronal proton density sequence without injected contrast (TR 4030, TE 39, 4mm slice thickness/spacing). Findings on the x-ray that indicate peroneal pathology are avulsion from the base of the fifth metatarsal, avulsion fracture of the distal fibular groove, os peroneum, and retromalleolar groove flattening. in the lateral ankle compartment but it may be used to reconstruct some pathologic conditions. There was a presence of peroneus quartus in one of the patients. Faced with pain or chronic instability after trauma, or lingering instability or strength deficit of the peroneal muscles in spite of well-conducted rehabilitation sessions, the possibility of a supernumerary PQ should be looked at. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in Nonsteroidal anti-inflammatory drugs, ice, rest or immobilization, and physical therapy. It is unknown if variant peroneus brevis insertion on the calcaneus can be identified by history or clinical exam. Lattaque du pas se fait ainsi par le bord latral du pied. Furthermore, in patients with this type of postural disorders, some muscle strength imbalance was described between the tibialis posterior and the peroneus brevis . The .gov means its official. Review the evaluation of peroneal tendon syndromes. There was no deficit of the tibialis posterior muscle. Accessory peroneal muscles are a group of accessory muscles that can occur in the foot region as a normal variant in some individuals. If promptly diagnosed, and surgical treatment of peroneal tendon injuries are required, athletic patients may return to sport by three months with successful outcomes. Rerouting the peroneal tendons underneath the calcaneofibular ligament. In the acute setting, one would expect a significant amount of surrounding edema on MRI. JBJS Br 8:11341137, Clarkson MJ, Fox JN, Atsas S, Daney BT, Dodson SC, Lambert HW (2013) Clinical implications of novel variants of the fibularis (peroneus) quartus muscle inserting onto the cuboid bone: peroneocuboideus and peroneocalcaneocuboideus. If the fibular groove is shallow endoscopic or open fibular groove deepening can be performed to provide a better structure for the peroneal tendons. Generating an ePub file may take a long time, please be patient. 24 year old male with variant peroneus brevis tendon insertion on the calcaneus. The muscle has often been implicated as a cause of pain in the lateral ankle region, and subluxation or attrition of the peroneal tendons. Anomalous peroneal tendon insertion masquerading as a retracted tendon tear: case report. Additional X-ray views are the axillary/Harris heel view and AP, lateral and oblique views of the foot to look for other fractures and foot alignment. There is a peroneal tenosynovitis. Patients can get back to sports or athletic activities after a few months. Most times this muscle is asymptomatic and is only fortuitously discovered. Images were evaluated for the peroneus brevis tendon inserting on the peroneal tubercle, and absent at the base of the fifth metatarsal. TECHNIQUE: Siemens Verio 3T, axial proton density sequence without injected contrast (TR 4830, TE 35, 4mm slice thickness/spacing). [2] Sometimes anomalous anatomy can lead to a peroneal disorder such as low lying brevis muscle belly or the presence of peroneus quartus muscle. A normal peroneus longus tendon (long arrow) is also annotated. They commonly occur at the level of the retromalleolar groove. Lobjectif de ce cas clinique est de discuter limputabilit de la prsence dun quatrime fibulaire bilatral, chez un patient souffrant dinstabilit chronique. They named this the retromalleolar attrition syndrome. The peroneus quartus is a muscle that typically arises from the peroneus brevis and attaches to the calcaneus and has been used for surgical reconstruction of the retromalleolar groove, functioning as a strap to stabilize the peroneal tendons. The frequent occurrence of this muscle in humans is suggestive of a progressive evolutionary change to evert the foot in order to assume a bipedal gait. The peroneus quartus is an anomalous muscle found in 6.6% to 22% of individuals. Peroneal tendonitis presents as a sharp or aching sensation along the length of the tendons or on the outside of your foot. A normal peroneus longus tendon (long arrow) and calcaneofibular ligament (open arrowhead) are also annotated. and seven out of 32 (22%) for Chepuri et al. Ankle radiographs were normal (figure 5). An official website of the United States government. Arthrosc Tech. It seems relevant to discuss, around the clinical case of this patient, the impact of this muscle on ankle instability especially when faced with lingering weakness of the peroneus brevis and longus muscles in spite of eccentric strength training and in the absence of any neurological impairment. peroneus quartus muscle or a low-lying muscle belly makes individuals also more susceptible for peroneal tendon dislo-cation [37, 42, 43]. Failure to recognize this variant may result in the incorrect diagnosis of a peroneus brevis tendon rupture and an unnecessary attempt at reparative surgery. The peroneus brevis is more often torn isolated peroneus longus tears occur less frequently. Google Scholar, Choudhary S, McNally E (2011) Review of common and unusual causes of lateral ankle pain. The patient had no prior surgical history or significant medical history. The symptoms disappeared after surgical resection of the PQ muscle followed by short immobilization time and rehabilitation training. Several hypotheses were emitted by these different authors to try and explain the onset of such symptoms. As for the ligaments, some scarring was noted on the left anterior talofibular ligament. Les clichs dynamiques ne mettent pas en vidence de laxit en tiroir antrieur. [6] Ankle drawer test should be done to asses ankle ligamentous stability. Functional ankle instability (FAI) is a common reason for consulting a physical medicine and rehabilitation physician specialized in sports trauma. [8] The retromalleolar groove has different shapes; a cadaveric study showed out of 178 ankles the groove is concave in 82%, flat in 11 % and convex in 7% with a non-osseous fibrocartilaginous ridge that is on the medial side of the groove. FOIA FINDINGS: Contiguous axial proton density MRI images of the right ankle demonstrate the peroneus brevis tendon (short arrow) descending to its attachment on the calcaneal, 24 year old male with variant peroneus brevis tendon insertion on the calcaneus. doi: 10.1016/j.eats.2019.08.007. Among the bones, ligaments, tendons or muscles involved in ankle stability, muscles and tendons of the peroneus brevis and longus muscles are especially important . Quartus Prime enables analysis and synthesis of HDL designs, which enables the developer to compile their designs, perform timing analysis, examine RTL diagrams, simulate a design's reaction to different stimuli, and configure the target device with the programmer.. What is Altera Cyclone? Treasure Island (FL): StatPearls Publishing; 2022 Jan. Congenital variations of the peroneus quartus muscle: an anatomic study. Le reste de lexamen neurologique est sans anomalies. Another physical exam technique is to have the patient lay prone with a knee to 90 degrees flexion and examine for peroneal tendon subluxation. 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