Diagnosis and Surgical Management of Flexor Digitorum Accessorius Longus–Induced Tarsal Tunnel Syndrome

Wittmayer, Brian C.; Freed, Lewis

doi:10.1053/j.jfas.2007.08.007

Cited by 37 publications

(35 citation statements)

References 15 publications

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“…There are several case reports incriminating the FDAL muscle, a variant of FDA, compromising the space in the tarsal tunnel and hence a causing tarsal tunnel syndrome [2][3][4][5][6]16]. As observed in the present study, the fleshy origin of medial head of FDA extended into the tarsal tunnel in majority of the cases.…”

Section: Discussionsupporting

confidence: 71%

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Morphology of flexor digitorum accessorius muscle

Athavale¹,

Swathi

2011

Surg Radiol Anat

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Section: Discussionsupporting

confidence: 71%

“…A variant of the FDA muscle named flexor digitorum accessorius longus (FDAL), which passes through the tunnel, has often been incriminated as a cause of TTS. When present, this muscle is believed to compress the tibial nerve [2][3][4][5][6]16].…”

Section: Introductionmentioning

confidence: 99%

Morphology of flexor digitorum accessorius muscle

Athavale¹,

Swathi

2011

Surg Radiol Anat

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“…Tarsal tunnel syndrome may be caused by idiopathic conditions or for traumatic reasons (bone diseases, injuries to the ligament, thickening of the flexor retinaculum, hematoma, fibrosis, and iatrogenic damage to the nerves), tendon disorders (tendinopathy and flexor tenosynovitis), supernumerary muscles (accessory soleus muscle, medial fibulocalcaneal muscle, and particularly accessory flexor digitorum muscle [16]) or muscle hypertrophy (abductor hallucis muscle [17] or flexor hallucis muscle of the toes). The syndrome may be caused also by bone disorders (talocrural and subastragalar arthritis and arthropathy with talocalcaneal synovitis and synostosis [10], sustentaculum tali [11], sequelae of fracture, change in static foot posture), expansive lesions (ganglion cysts, particularly epineural ganglions [12], soft tissue tumors including intracanal lipomas and tumors of the nerves), vascular disorders (kinking of the tibial artery, venous aneurysms, and varicose plantar veins particularly in the distal tarsal tunnel, which is commonly reported in the literature) [2,8,13,14].…”

Section: Etiologymentioning

confidence: 99%

“…According to the literature [16], the accessory flexor muscle of the toes is a common cause of posterior tarsal tunnel syndrome. In our series, this disorder was detected in five patients (Fig.…”

Section: Muscle Disorders (N = 7)mentioning

confidence: 99%

Role of ultrasound in posteromedial tarsal tunnel syndrome: 81 cases

Fantino¹

2014

J Ultrasound

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Posteromedial tarsal tunnel syndrome is a disorder affecting the tibial nerve or its branches. Diagnosis is established on the basis of physical examination and can be confirmed by electrophysiological evidence. However, diagnostic imaging is always required to identify the possible site of compression. High-resolution ultrasound (US) is playing an increasingly important role in the study of the nerves thanks to a series of advantages over magnetic resonance imaging, such as lower costs and widespread availability, high spatial resolution, fast examination using axial scans, dynamic and comparative studies, possibility of carrying out a study with the patient in the standing position, US Tinel sign finding, and the contribution of color/power Doppler US. We present the results obtained in a series of 81 patients who underwent US imaging between 2008 and 2013 due to posteromedial tarsal tunnel syndrome. Keywords Tarsal tunnel Á Tibial nerve Á UltrasoundRiassunto La sindrome del tunnel tarsale posterioremediale è una sofferenza del nervo tibiale o di un suo ramo. La diagnosi è clinica e può essere confermata dall'elettrofisiologia, ma un'indagine con imaging è sempre necessaria per trovare l'elemento di compressione. L'ecografia ad alta risoluzione sta giocando un ruolo sempre più importante per lo studio dei nervi, per i diversi vantaggi rispetto alla risonanza magnetica: costo e disponibilità, risoluzione spaziale, esplorazione rapida mediante tecnica di scansione assiale, dinamica e comparativa, possibilità di uno studio con paziente in piedi, segno di Tinel ecografico, contributo del Doppler.

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“…The presence of accessory long digital flexor muscles in the leg was recorded almost 150 years ago (Wood 1864), but in the past two decades these structures have attracted renewed interest because of their implication in tarsal tunnel and flexor hallucis syndromes (Sammarco and Stephens 1990;Sammarco and Conti 1994;Canter and Siesel 1997;Lau and Daniels 1999;Burks and DeHeer 2001;Kinoshita et al 2003;Wittmayer and Freed 2007). Both of these syndromes manifest with pain in the foot and ankle, and can be caused by several different phenomena, rendering diagnosis and management problematic.…”

Section: Introductionmentioning

confidence: 99%

An unusual variation of the flexor digitorum accessorius longus muscle—its anatomy and clinical significance

Hwang

Hill

2009

Anat Sci Int

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In this article we describe a variant accessory muscle found in the deep posterior compartment of the leg in a 96 year-old female human cadaver. The flexor digitorum accessorius longus was found bilaterally, originating by two heads from the shafts of the tibia and fibula. The two heads of the muscle were observed to be subequal in size and none of the fleshy fibers of the muscle entered the tarsal tunnel. This stands in contrast with previous descriptions of accessory digital flexors, which are typically asymmetrical or single-headed, and which almost always introduce fleshy fibers into the tarsal tunnel. This variant structure has the potential to entrap the tibial nerve and compress the posterior tibial vessels either proximal to the talocrural joint or within the tarsal tunnel, and may be implicated in clinical scenarios involving imaging, surgery, compartment syndromes, or deep-vein thromboses.

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Diagnosis and Surgical Management of Flexor Digitorum Accessorius Longus–Induced Tarsal Tunnel Syndrome

Cited by 37 publications

References 15 publications

Morphology of flexor digitorum accessorius muscle

Morphology of flexor digitorum accessorius muscle

Role of ultrasound in posteromedial tarsal tunnel syndrome: 81 cases

An unusual variation of the flexor digitorum accessorius longus muscle—its anatomy and clinical significance

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