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Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles. Radiology. 2007 Feb;242(2):509-17
Saupe N, Mengiardi B, Pfirrmann CW, Vienne P, Seifert B, Zanetti M
Quote:
PURPOSE: To evaluate prospectively, on magnetic resonance (MR) images in volunteers with asymptomatic ankles, various features of anatomic variants that are potentially associated with peroneal tendon disorders.
MATERIALS AND METHODS: The study had institutional review board approval; informed consent was obtained from each volunteer. The prevalence of accessory peroneus quartus muscles, the location of the muscle-tendon junction of the peroneus brevis muscle, the prevalence and size of the peroneal tubercle and the retrotrochlear eminence, and the shape of the retromalleolar fibular groove were evaluated on MR images in 65 volunteers with asymptomatic ankles (35 women, 30 men; age range, 23-70 years; median age, 45 years). MR images were analyzed by two radiologists in consensus. The relationship between anatomic features and age and sex was analyzed by using Spearman rank correlation and the Wilcoxon rank sum test.
RESULTS: A peroneus quartus muscle was identified in 11 (17%) ankles. Ninety percent of the musculotendinous junctions of the peroneus brevis muscle were located in a range between 27 mm proximal to and 13 mm distal to the fibular tip (median, 0 mm). A peroneal tubercle was identified in 36 (55%) ankles. Ninety percent of all peroneal tubercles were 4.6 mm or smaller (median height, 2.9 mm). A retrotrochlear eminence was seen in all ankles (median, 3.0 mm; 90% were 4.6 mm or smaller). The retromalleolar groove was concave in 18 (28%), flat in 28 (43%), convex in 12 (18%), and irregular in seven (11%) volunteers. A significant difference (P = .04) for the height of the retrotrochlear eminence was found between men (median, 3.4 mm) and women (median, 2.5 mm). All other P values were greater than .05.
CONCLUSION: Anatomic variants thought to predispose individuals to peroneal tendon disorders can be seen in volunteers with asymptomatic ankles
Re: Anatomic variants and peroneal tendon disorders
The peroneus quartus muscle: clinical correlation with evolutionary importance.
Athavale SA, Gupta V, Kotgirwar S, Singh V. Anat Sci Int. 2012 Jan 18
Quote:
The peroneus quartus (PQ) is an accessory muscle of the peroneal/lateral compartment of the leg. The muscle has often been implicated as a cause of pain in the lateral ankle region, and subluxation or attrition of the peroneal tendons. The present study was aimed at observing the prevalence and morphology of this muscle in human cadavers. Ninety-two embalmed lower limbs were dissected for this study. The PQ muscle was found in 21% of the limbs. In all these limbs it originated from the lower part of the lateral surface of the fibula, the undersurface of peroneus brevis and the posterior intermuscular septum. In the majority of limbs, insertion was on the retrotrochlear eminence of the calcaneus. Taking into account the possibility of this muscle being a cause of lateral ankle pathology, the present study attempts to correlate the findings with the anatomy of the surrounding region. 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.
Re: Anatomic variants and peroneal tendon disorders
Let us always remember that peroneus quartus and quinti are the norm in many lesser primates; thus, one should always look for phylogenetic explanations for extra muscles. Also, do not forget that the upper limb homology is flexor carpi ulnaris - complete with sesamoid in the pisiform - thus when one see occasional sesamoids in the PL tendon around the cuboid, one should remember where one has come from, so to speak. I often think that the manner in which peroneus longus has mutlibitartite parts to its upper end may represent the quartus and quinti that have been subsumed into the main muscle. Thought for the day, Rob
Re: Anatomic variants and peroneal tendon disorders
Clinical Implications of Novel Variants of the Fibularis (Peroneus) Quartus Muscle Inserting onto the Cuboid Bone: Peroneocuboideus and Peroneocalcaneocuboideus
Mackenzie J. Clarkson, Jacob N. Fox, Stavros Atsas, Blake T. Daney, Sean C. Dodson, H. Wayne Lambert Journal of Foot and Ankle Surgery; Article in Press
Quote:
Two variants of the fibularis (peroneus) quartus muscle were identified and photographed in the legs of a 70-year-old white male cadaver. A rare peroneocuboideus (fibulocuboideus) muscle (as described by Chudzinski) and a novel peroneocalcaneocuboideus (fibulocalcaneocuboideus) muscle was found in the right and left leg, respectively. The latter muscle has not been previously reported and was termed “peroneocalcaneocuboideus” on the basis of its origin and insertions. Also, the distal attachment of both muscles inserted onto the distal lip of the peroneal sulcus of the cuboid bone, which differs from the historical data. The insertion of the peroneocuboideus muscle was previously described as being at the tuberosity of the cuboid bone or, simply, the lateral surface of the cuboid. Therefore, the present case study provides the first gross anatomic photographs of these variant leg muscles along their entire length, identifies a novel fibularis quartus variant, and describes a new insertion site for the peroneocuboideus muscle. Throughout our report, the historical data are reviewed to list the prevalence and describe the clinical implications of the fibularis quartus muscle and its variants. The presence of variant fibularis quartus muscles has been known to cause lateral ankle pain and stenosis, ankle instability, fibular tenosynovitis, subluxation of the fibular (peroneal) tendons, and longitudinal splitting of the fibularis brevis tendon in radiologic and case studies. Therefore, surgeons, radiologists, and clinicians should be aware of these variant muscles when considering various diagnoses, interpreting radiographs, and pursuing surgical intervention to relieve lateral ankle pathologic features.
Anatomic variants and peroneal tendon disorders
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