Accessory muscles around the foot and ankle presenting as chronic undiagnosed pain

NewsBot · Oct 2, 2013

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Accessory muscles around the foot and ankle presenting as chronic undiagnosed pain. An illustrative case report and review of the literature.
Al-Himdani S, Talbot C, Kurdy N, Pillai A.
Foot (Edinb). 2013 Aug 27.

The differential diagnosis of ankle pain is extensive. Pathology may be classified as intra- or extra-articular. Additionally, ankle pain may be traumatic or non-traumatic. One of the unusual differential diagnoses for pain in the ankle is an accessory muscle. Magnetic resonance imaging is the radiological investigation of choice. However, this is invariably reported as normal unless one specifically looks for an accessory muscle. The purpose of this report is to highlight important features of these muscles and to draw attention to this uncommonly reported condition.
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NewsBot · Oct 2, 2013

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The plantaris tendon and a potential role in mid-portion Achilles tendinopathy

NewsBot · Mar 1, 2015

Unilateral Accessory Plantaris Muscle: A Rare Anatomical Variation
with Clinical Implications
Dr. Sherry Sharma, Dr. Meenakshi Khullar & Dr. Sunil Bhardwaj
Global Journal of Medical Research: H
Orthopedic and Musculoskeletal System
Volume 14 Issue 4 Version 1.0 Year 2014

Plantaris, a small muscle with its long slender tendon, is of interest not only from
anatomical but also from phylogenetic view point. It is regarded as vestigial in man, believing
that, with assumption of an erect posture, the tendon lost its original insertion into plantar
aponeurosis and gained a secondary calcaneal attachment. The muscle is known to exhibit
variations but there are few reports on the existence of complete duplication of plantaris. During
the routine dissection for the undergraduate medical students we encountered unilateral
accessory plantaris muscle in the right lower limb of an adult male cadaver. Though often
dismissed as a small vestigial muscle, an injury to this muscle should actually be included in the
differential diagnosis of the painful calf.
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NewsBot · May 2, 2015

Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy
Jorge Pablo Batista, Jorge Javier del Vecchio, Pau Golanó and Jordi Vega
Case Reports in Orthopedics
Volume 2015 (2015), Article ID 823107, 4 pages

Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of the flexor hallucis longus (FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of the flexor hallucis longus in patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion.
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NewsBot · Oct 27, 2018

Two accessory muscles of leg: potential source of entrapment of posterior tibial vessels
Satheesha B. NayakSurekha Devadasa Shetty
Surgical and Radiologic Anatomy: 23 October 2018

Accessory muscles can be found in any part of the body. In most of the regions, they go unnoticed. However, in some cases, they become symptomatic or of cosmetic concern. In this particular case, the presence of two accessory muscle slips was observed in the flexor compartment of the leg. Among the two, the first accessory muscle belly connected the lower part of flexor hallucis longus to the tibialis posterior. The muscle crossed superficial to the posterior tibial vessels. The second accessory muscle took origin from the connective tissue around the lower part of the posterior tibial vessels and was inserted to the upper part of the lateral border of tibia near the attachment of the interosseous membrane. One of the accessory muscles crossed the posterior tibial vessels, while the other surrounded them. The above accessory muscles were supplied by the branches of tibial nerve.
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NewsBot · May 24, 2019

M. Peroneus Quartus Causing Chronic Peroneal Compartment Syndrome in a Runner Treated by Endoscopic Fasciotomy: A Case Report
Markus Wenning et al
JFAS; Article in Press

We present the rare case of a 47-year-old male long-distance runner who was referred to our hospital with a longstanding pain in his left calf. Clinical history, as well as ultrasound and magnetic resonance imaging scans, showed an accessory peroneal muscle. This muscle was identified as a peroneus quartus muscle. On ultrasound, controlled intracompartmental pressure measurement, a chronic peroneal compartment syndrome, was diagnosed. We performed an endoscopic-assisted fasciotomy of the peroneal compartment. This resolved the patient's symptoms completely and allowed the runner to return to competition shortly after the surgery.
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NewsBot · Oct 12, 2019

Chronic Lateral Ankle Pain – Overcrowding Due To Peroneus Quartus Muscle. A Case Report.

NewsBot · Mar 18, 2020

Proposal for a new classification of plantaris muscle origin and its potential effect on the knee joint
Ł. OlewnikaK.KurtysaB.GoneraaM.PodgórskicM.SibińskidM.Polgujb
Annals of Anatomy - Anatomischer Anzeiger; 12 March 2020, 151506

Purpose
The plantaris muscle (PM) is typically characterized by a short, slim and spindle-shaped muscle belly and long, thin tendon. It is situated posterior to the popliteal muscle, and anterior to the lateral head of the gastrocnemius muscle (GM). Little information exists regarding the high variability of origin of the PM. The main aim of the study was hence to characterize the morphology of the PM and its place of origin, classify it and evaluate its prevalence.

Methods
Classical anatomical dissection was performed on 142 lower limbs (77 left, and 65 right) fixed in 10 % formalin solution. The morphology of the origin of the PM and its prevalence was evaluated.

Results
The PM was present in 128 lower limbs (90.1 %). Six types of origin were observed, the most common being Type I (48.4 %). This type was divided into two subtypes (A-B): subtype A attaching to the lateral head of the GM, lateral femoral condyle and to the capsule of the knee joint, and subtype B, attaching to the lateral head of the GM, the lateral femoral condyle, knee joint capsule and the popliteal surface of the femur. The second most common type was Type II (25 %), attaching to the capsule of the knee joint and, indirectly, to the lateral head of the GM through the lateral femoral condyle. The third most common type was Type III (10.15 %), attaching to the lateral femoral condyle and the knee joint capsule. Type IV (6.25 %), the rarest type, attached to the lateral femoral condyle, knee joint capsule and to the iliotibial band. Type V (8.6 %) originated only from the lateral condyle of the femur. Type VI (1.6 %) contains only "rare cases".

Conclusion
The PM presents high morphological variability, and its status as a residual muscle should be reconsidered. Our presented classification of its types of origin is a valuable addition for both clinicians and anatomists.
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