The Accessory Soleus Muscle

NewsBot · Mar 24, 2020

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The Accessory Soleus Muscle: A narrative review of the literature
Aggeliki Bistaraki et al
Journal of Long-Term Effects of Medical Implants

Purpose Although the accessory soleus muscle is a rare supernumerary muscle of the leg, its presence has been well discussed in the literature. This rare anatomic variation has been described mainly in the anatomic, surgical and radiology literature. Awareness of the muscle’s presence and its clinical presentation can help with diagnosis without surgical exploration. The purpose of this narrative review was to summarize the available data describing the anatomy, clinical presentation, diagnosis, associated pathologies and treatment options of this accessory muscle. Methods A literature review was performed with the aim to provide a comprehensive report of the existing data regarding the accessory soleus muscle. PubMed, Heal Link and Google Scholar were searched for articles in English reporting on the accessory soleus muscle. The search was conducted using the following keywords: “soleus muscle” and “accessory soleus muscle”. PubMed was searched primarily and then cross-referenced articles were found via Heal Link and Google Scholar. Results from non-English studies were excluded. Results A total of 148 articles were reviewed. The majority of the articles was comprised of case reports along with a review of the literature. After the initial screening, 33 irrelevant studies, 47 duplicates and 9 non-English articles were excluded, thus, 59 studies were eligible for analysis. Conclusion While the accessory soleus muscle is a rare anatomic variation, many cases have been reported in the literature. Nonetheless, the results reported in this literature review are still inconclusive in regards to why some patients are symptomatic or not and to the recommendation of
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NewsBot · Mar 24, 2020

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NewsBot · Aug 11, 2020

Ultrasound and Magnetic Resonance Imaging Diagnosis of Isolated Tear of the Accessory Soleus Tendon: A Case Report and Review of the Literatures
I Simonetti, F Di Pietto, M Zappia, P Trovato, F Verde, V Chianca
JOCR March – April 2020

Introduction: The accessory soleus muscle (also known as the supernumerary soleus or soleus secundus) is an uncommon congenital anatomical. The presence of this muscle is generally asymptomatic. In cases of symptomatic accessory soleus muscle, it manifests with painful swelling of the posteromedial region of the ankle. To the best of our knowledge, partial or complete accessory soleus tendon tears were reported in literature in only three cases; all of them were diagnosed with magnetic resonance imaging (MRI) examination while only one was diagnosed with both ultrasound (US) and MRI.
Case Report: We presented a case of a 63-year-old Caucasian woman presented to our emergency department with severe pain in the posteromedial region of her right ankle. US and MRI of the calf and ankle were performed and a complete tear of the right accessory soleus tendon with fluid gap and myotendinous retraction was diagnosed.
Conclusion: An accessory soleus muscle partial or complete tears are very uncommon injuries. This condition can mimic many other pathologies, and therefore, radiologists should know the physiological and pathological imaging findings for a correct interpretation of ankle injuries, avoiding misinterpretations.
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NewsBot · Sep 22, 2020

Accessory Soleus Muscle: Two Case Reports with a Completely Different Presentation Caused by the Same Entity
Mihovil Plečko et al
16 Sep 2020

Accessory soleus muscle (ASM) is a rare supernumerary anatomical variant that commonly presents as a posteromedial ankle swelling, which may become painful during physical activity. As it may mimic a soft tissue tumor, it is essential to differentiate this condition from ganglion, lipoma, hemangioma, synovioma, and sarcoma. However, ASM may also present with a painful syndrome, characterized by pain and paresthesia of the ankle and foot, mimicking the tarsal tunnel syndrome (TTS). Two cases of ASM are presented in this article. The first case had a typical presentation with painful posteromedial ankle swelling. After the initial assessment, the diagnosis was confirmed by magnetic resonance imaging (MRI), and ASM was treated by complete resection. The second case presented with pain and paresthesia in the right ankle and foot, but no swelling was noticeable. It was initially misdiagnosed by a rheumatologist and afterward overlooked on an MRI by a musculoskeletal radiology specialist and therefore mistreated by numerous physicians before being referred to our outpatient clinic. After further assessment, the diagnosis has been confirmed, and ASM was treated by complete resection combined with tarsal tunnel decompression. To the best of our knowledge, this is the first case reported in which ASM caused symptoms but presented without posteromedial swelling. This might be due to a proximally positioned belly of the ASM, followed by a tendinous insertion on the medial side of the calcaneus.
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NewsBot · Oct 6, 2020

Accessory Soleus Muscle: Two Case Reports with a Completely Different Presentation Caused by the Same Entity
Mihovil Plečko et al
Case Rep Orthop. 2020 Sep 14;2020

Accessory soleus muscle (ASM) is a rare supernumerary anatomical variant that commonly presents as a posteromedial ankle swelling, which may become painful during physical activity. As it may mimic a soft tissue tumor, it is essential to differentiate this condition from ganglion, lipoma, hemangioma, synovioma, and sarcoma. However, ASM may also present with a painful syndrome, characterized by pain and paresthesia of the ankle and foot, mimicking the tarsal tunnel syndrome (TTS). Two cases of ASM are presented in this article. The first case had a typical presentation with painful posteromedial ankle swelling. After the initial assessment, the diagnosis was confirmed by magnetic resonance imaging (MRI), and ASM was treated by complete resection. The second case presented with pain and paresthesia in the right ankle and foot, but no swelling was noticeable. It was initially misdiagnosed by a rheumatologist and afterward overlooked on an MRI by a musculoskeletal radiology specialist and therefore mistreated by numerous physicians before being referred to our outpatient clinic. After further assessment, the diagnosis has been confirmed, and ASM was treated by complete resection combined with tarsal tunnel decompression. To the best of our knowledge, this is the first case reported in which ASM caused symptoms but presented without posteromedial swelling. This might be due to a proximally positioned belly of the ASM, followed by a tendinous insertion on the medial side of the calcaneus.
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NewsBot · Dec 29, 2020

Story of a superfluous muscle accessory soleus muscle
sprain: Imaging and diagnostic approach!
Suvinay Saxena et al
Indian Journal of Medical Sciences

Accessory soleus muscle is a rare supererogatory variant, which presents as a mass in posterior compartment of ankle.
It can present through a myriad of clinical features ranging from asymptomatic to sprain to complete tear. The pain
with accessory soleus can be attributed to either compression of tibial nerve, exertional compartment syndrome and
very rarely can be secondary to sprain or tears of the accessory soleus muscle. Very few cases have been documented
with soleus muscle injuries. We would like to highlight the importance of imaging in diagnosis and management.
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NewsBot · Aug 3, 2021

An Accessory Muscle of the Posterior Compartment of
Leg of Clinical Significance: A Cadaveric Case Report
J. Maggard; T. Zarbock & M. Jorgensen
Int. J. Morphol., 39(4):1054-1057, 2021.

Accessory and anomalous muscles are common in humans, although their unique morphologic characteristics can
make accurate identification difficult. In this case report, we attempt to identify an anomalous accessory muscle of the posterior compartment
of the leg [Compartimentum posterius cruris] detected during cadaveric dissection and discuss its clinical significance. The muscle was
found on the right lower limb of an 81-year-old female cadaver and extended from the distal femur to attach to the gastrocnemius muscle
at the point where the medial and lateral heads fuse. At its origin, the muscle was found lateral to the popliteal vessels and crossed
posterior to these vessels and tibial nerve. It displayed characteristics similar to both an accessory plantaris muscle and gastrocnemius
tertius, thus making its ultimate identification difficult. Though the muscle displayed a morphologically similar appearance to the plantaris,
we suggest that its common insertion with the gastrocnemius best identifies it as a gastrocnemius tertius. In addition, due to its relationship
with the popliteal neurovasculature, it is possible that this muscle could have resulted in neurovascular entrapment although it is unknown
whether or not this cadaver exhibited symptoms.
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NewsBot · May 15, 2022

Accessory Soleus Muscle in a 79-Year-Old Female Cadaver: A Case Report
Niloofar Ghyasi et al
FASEB J. 2022 May;36 Suppl 1

In the present case report, we describe characteristics regarding a rare accessory soleus muscle (ASM) that was discovered and measured. The ASM is found in about 6% of people, and is most commonly asymptomatic (Mukish et al., 2012). The most common symptomatic presentation includes a soft mass in the posteromedial distal third of the leg. Pain is also present in around two-thirds of symptomatic cases (Mukish et al., 2012). This unilateral anomaly was found during a routine dissection of the left lower ankle in a 79 year old female cadaver. In the present case, the ASM tendon originates from the middle of the tibia and inserts via tendinous insertion onto the medial surface of the calcaneus; this is one of four possible insertion variations already described in the literature. This particular insertion variation is described as Type A (Tubbs et al., 2016). The length of the muscle is [17cm] at the insertion point of the superior tendon to the inferior tendon. This accessory soleus variation has been shown to cause various clinical implications such as tibial nerve compression neuropathy in patients (Badr et al., 2020). Clinical symptoms experienced by patients due to presence of ASM are significant enough to require surgical removal of this muscle to relieve symptoms (Badr et al., 2020). Due to both the known and unknown clinical implications of the variation, it is pertinent to properly describe this so as to benefit future clinical and surgical outcomes for all patients.
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NewsBot · Jul 2, 2022

Anatomical Variability of the Soleus Muscle: A Key Factor for the Prognosis of Injuries?

NewsBot · Jan 19, 2023

Symptomatic accessory soleus muscle: A cause for exertional compartment syndrome in a young soldier: A case report
Inha Woo et al
World J Clin Cases. 2022 Dec 16;10(35):13022-13027

Background: Accessory soleus muscle (ASM) is a rare congenital variation that is almost asymptomatic, but several papers have recently described symptomatic ASM. The clinical features of this condition are similar to tarsal tunnel syndrome (TTS) and include pain and numbness around the medial side of the ankle. ASM commonly originates from the fibula or soleus muscle and inserts into the Achilles tendon or calcaneus. Usually, it is identified as posteromedial swelling and definitely diagnosed by magnetic resonance imaging. In most cases, treatment is observation, but surgical excision can be considered if symptoms are severe.

Case summary: A 23-year-old male Korean soldier presented with complaints of bilateral foot and ankle pain and a swelling medial to the Achilles tendon that was more pronounced on the right side. Symptoms first occurred after playing soccer 10 mo before this presentation, worsened after physical exertion, and were relieved by rest. He had no medical history, and no one in his family had the condition. Laboratory results were non-specific. Several tests were performed to exclude common diseases such as tumors or TTS. However, MRI revealed a bulky accessory soleus muscle in both feet, though the patient complained of more severe pain on the right side during physical activity. Accordingly, surgical resection was adopted. At surgery, a large accessory soleus muscle was noted anterior to the Achilles tendon with distinctive insertion from a normal soleus muscle. At 12 mo after surgery, there was no pain, numbness, or swelling of the right foot or ankle, no evidence of recurrence, and the patient could do all sports activities.

Conclusion: Accessory soleus muscle should be added to the list of differential diagnosis if a patient has pain, sole numbness or swelling of the posteromedial ankle.
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NewsBot · Jun 5, 2023

Accessory Tibionavicular Muscle: An Unusual Cause of Medial Ankle Pain
Karthikeyan P. Iyengar , Gaurav Kant Sharma , Rajesh Botchu
Indian J Radiol Imaging

Accessory or anomalous muscles around the ankle are not uncommon and are usually asymptomatic. They are traditionally encountered during imaging undertaken for evaluation of ankle pain. We reported the first case of a new accessory muscle in the anteromedial part of the ankle with associated partial thickness tear in an 18-year-old football player presenting as symptomatic pathology. In this article, we described the role of cross-sectional imaging in its diagnosis including successful management of the condition with ultrasound-guided platelet-rich plasma therapy and review-associated literature.
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