A, Frontal 3D CT image of calcaneus in cadaver shows shelflike prominence of medial plantar process (arrow) where central and lateral cords of plantar fascia inserts. * = extensor digitorum brevis . 5A Images of medial plantar process. Patients with this fracture present with pain and swelling in the dorsolateral midfoot that is similar to those who have an anterior calcaneal process fracture. This configuration gives it the viscoelasticity that allows it to absorb and adapt to forces that can approach 612.5 times body weight during running [7, 8]. Avulsion of the Flexor Digitorum Profundus. The proximal attachment of the bifurcate ligament, an important stabilizer in plantar and dorsal flexion of the ankle, attaches to this process. The medial part of muscle known as the extensor hallucis brevis ends in a tendon and get inserted into the dorsal surface of the base of the proximal phalanx of big toe; The other three tendons get inserted into the lateral side of tendons of the extensor digitorum longus of toes 2,3 and 4; ACTION. The middle talar facet is an inclined oval surface on the roof of the sustentaculum. There is an avulsion from calcaneum at the origin of extensor digitorum brevis muscle. 82 Skeletal Radiol (2009) 38:81-84 Fig. Epub 2015 Jun 10. . The contralateral side was examined for comparison and shows normal findings. Fractures in the medial process of the calcaneus may occur as a result of compressive or tensile forces. As such, articles are written and edited by countless contributing members over a period of time. The Achilles tendon is the strongest tendon in the body and has an average length of 15 cm. if (document.context) document.write ("&context=" + escape(document.context)); The EDB avulsion fracture may also be mistakenly identified as an os peroneum, but the latter resides more inferiorly and is completely corticated. A, 22-year-old man who sustained fracture during football game. Long axis as well as short axis There is an avulsion from calcaneum at the origin of extensor digitorum brevis muscle. The calcaneus is the largest bone in the foot and serves as the primary weight bearing structure in the heel. B, Sagittal T1-weighted MR image obtained 6 weeks after injury shows thickened Achilles tendon. MRI of Ankle and Lateral Hindfoot Impingement Syndromes. extensor digitorum brevis manus (EDBM) extensor medii proprius (EMP) extensor indicis et medii communis (EIMC) Differential Ganglion cysts Synovitis both produce dorsal wrist pain Treatment Nonoperative observation indications first line treatment Operative surgical decompression of 4th dorsal compartment (aEIP) or reduction of muscle belly (EDBM) The Extensor digitorum brevis - occasionally referred to as EDB - is a small muscle on the dorsum of the foot that is involved in the extension of digits two-through-four. Anterior talofibular and calcaneofibular ligaments are normal. 4); and type 4, small beak fracture avulsed from the deep fibers of the tendon [9, 10]. Avulsion fractures at the EDB origin from the anterior process of the calcaneus may also occur and may be difficult to distinguish from those of the dorsal calcaneocuboid or bifurcate ligaments, although they typically produce a larger fracture fragment. Bookshelf Sagittal T1-weighted (a) and STIR (b) MR images of the foot demonstrate cortical irregularity of the mid-diaphysis of the metatarsal bone (arrow). Paediatrics {"url":"/signup-modal-props.json?lang=us\u0026email="}, Patel M, Extensor digitorum brevis avulsion. The main function of the Extensor Digitorum Brevis Muscle is to control the movement of the toes. Osseous erosions, all of which avulsion fracture of the spinous pro- metastases rarely cross intervertebral can reduce normal cess of the C6 or C7 vertebra caused by disk spaces, whereas infectious osteo- range of motion and, in abrupt hyperflexion of paraspinal mus- myelitis often erodes the vertebra and severe cases, lead to cles. Post-traumatic left foot pain for the last 2 days. Types 1 and 2 fractures usually are avulsive, whereas most type 3 fractures are compressive. A fracture through abnormal or diseased bone and commonly occurring with little or no trauma. Clipboard, Search History, and several other advanced features are temporarily unavailable. . 1). neurologic. There is another avulsion fracture from cuboid at cuboid - 5th metatarsal joint. B, Sagittal STIR MR image shows avulsion of central cord of plantar fascia with perifascicular edema (arrow) as well as bone edema surrounding bone defect. Download Citation | On Aug 15, 2020, Ammar Haouimi and others published Extensor digitorum brevis avulsion | Find, read and cite all the research you need on ResearchGate Podiatry Books There is another avulsion fracture from cuboid at cuboid - 5th metatarsal joint. Common calcaneal avulsion fracture. Fig. 3); type 2, beak fracture with a horizontal fracture extending into the posterior body; type 3, infrabursal avulsion by the superficial fibers of the middle third of the Achilles tendon (Fig. We will eventually. 1989 Oct;79(10):514-6. doi: 10.7547/87507315-79-10-514. Case study, Radiopaedia.org (Accessed on 11 Dec 2022) https://doi.org/10.53347/rID-60971. The two mechanisms of injury that result in a fracture of the anterior calcaneal process are compression or impaction forces and extreme tensile forces [29]. Extensor digitorum brevis avulsion fracture: Avulsion can occur at origin of EDB at insertion into superolateral aspect of calcaneus. B, Axial proton-density MR image shows that avulsion occurred distally at cuboid attachment manifested as gap (arrow) between ligament and cuboid. 10A 21-year-old male basketball player who inverted his foot and had pain laterally. Nine major extensor tendons are located at the dorsal aspect of the wrist. Fig. Learn all about Interosseous Nerve Compression. This paper attempts to familiarize the podiatrist with the pathologic entity of avulsion fracture at the extensor digitorum brevis muscle origin and its mechanism of injury, clinical presentation, and treatment. Anteriorly, the calcaneus is entirely covered with cartilage forming the surface that articulates with the cuboid. Lateral radiograph shows superiorly displaced bone fragment (curved arrow) and donor site defect in superior aspect of calcaneal tuberosity (straight arrow). HHS Vulnerability Disclosure, Help Mallet Finger. The fibers of the central cord envelop the aponeurosis of the flexor digitorum brevis muscle. An avulsion fracture is where a fragment of bone is pulled away at the ligamentous or tendinous attachment. The avulsed fragment had arisen from the 369 Fulham Road, base of the third metacarpal and was clearly identified in London SW10 9NH, UK e-mail: gonzaloansede@gmail.com continuation with the extensor carpi radialis brevis. 64 Section . Fig. The EDB muscle is broad and thin. As such, articles are written and edited by countless contributing members over a period of time. Subtalar joints. This vulnerability may be due to progressive loss in height of the motion segment noted by the authors due to visoelastic deformation and creep resulting from repeated loading without sufficient periods . It passes obliquely across the dorsum of the foot, and ends . 1969 Jun;92(7):1439-46. doi: 10.1148/92.7.1439. Most injuries are caused by high-energy trauma that result in intraarticular fractures [1]. The extensor pollicis longus (EPL) tendon resides within the 3 rd dorsal extensor compartment of the wrist, inserts upon the distal phalanx of the thumb, and is the primary extensor of the thumb. Bethesda, MD 20894, Web Policies JF Norfray, LF Rogers, GP Adamo, HC Groves, WJ Heiser. The lateral branch of the deep fibular nerve travels under the extensor retinaculum, as well as the extensor digitorum and hallucis brevis muscles to innervate these muscles and nearby joints. Anatomy Teaching & Learning Fig. . Dorsal foot. A, Frontal radiograph shows swelling in lateral foot with its epicenter just proximal to base of fifth metatarsal bone (straight arrow). there are four types of avulsion fractures ( fig. Forced inversion of the foot is considered the mechanism of injury so that the EDB is rapidly stretched beyond its physiologic limits resulting in a tear of the muscle along with an avulsion fracture [32]. 9A 32-year-old female tennis player who inverted her foot and had dorsolateral bruising in foot. This site needs JavaScript to work properly. The fracture is best depicted on the anteroposterior projection of the ankle or the frontal projection of the foot, and it characteristically appears as variably sized fragments of bone arising from the dorsolateral aspect of the anterior calcaneus (Fig. 3 59-year-old man with type 1 calcaneal avulsion fracture who felt pop and acute posterior heel pain. Maneuvers that adduct the forefoot exacerbate pain. Abdelrahman, . A pitfall is a normal small ossicle, the os calcaneus secondarius, which is adjacent to the anterior calcaneal process mimicking this fracture; however, these ossicles, which are seen in about 25% of the population, are completely surrounded by lamellar bone [33, 34] (Fig. Extraarticular fractures are categorized as either compressive or avulsive types. Articles. 7B 25-year-old man who fell while skiing. Fig. A patient has right shoulder pain. [38] classified these injuries into four types depending on the size of fracture and angulation of the calcaneocuboid joint with stress: type 1, no fracture and an increased angle by 510; type 2, occasional fracture flake and angulation greater than 10; type 3, osseous fragment greater than 5 mm and angulation greater than 10; and type 4, compression fracture of medial cuboid and major joint distraction. Because these fractures may be extremely difficult to detect, either CT or MRI is required to confirm the diagnosis in many cases, particularly when pain becomes chronic [23, 27, 28]. [9]). Check for errors and try again. B, 30-year-old man who did not have trauma. Podiatry Schools & Programs Distally, the tendon has a concave anterior and convex posterior surface tapering to its broad enthesis on the calcaneus located at the middle third of the posterior surface of the calcaneal tuberosity. Unable to load your collection due to an error, Unable to load your delegates due to an error. Fragment arising from the dorsal base of the distal phalanx with fixed flexion. A global group of dedicated editors oversee accuracy, consulting with expert advisers, and constantly reviewing additions. The most common cause is osteoporosis, Metastatic bone disease (lytic, blastic, or mixed lesions) secondary to carcinomas that metastasize to bone: breast, brain, thyroid, kidney and prostate. At the midbody level, a small prominence marks the attachment of the calcaneofibular ligament. sharing sensitive information, make sure youre on a federal (Drawings by Yu JS). 2007 Shaw Bronner. You can use Radiopaedia cases in a variety of ways to help you learn and teach. (A) The flexor digitorum longus, flexor hallucis longus, peroneus brevis, soleus, and extensor digitorum muscles are examined at this level for strain, tears, or fatty atrophy that may suggest denervation. It can be seen on routine radiograms and the problem it presents is one of diagnosis rather than treatment. Type 1 fractures are likely insufficiency The lateral segments course distally to insert on the middle phalanges of the second through fourth toes, whereas the most medial segment forms the extensor hallucis brevis. Another clinical and radiographic pitfall may be a small avulsion fracture of the EDB insertion; however, in our experience, even small EDB fracture fragments contain more bone than just the cortex so they do not have the typical linear appearance of a calcaneocuboid ligament avulsion fracture. Radiograph and ultrasound show avulsion of extensor digitorum brevis from the calcaneum. If surgical needed excision of fragment,