Heterotopic Ossification of the Peroneus Longus Tendon in the Retromalleolar Portion with the Peroneus Quartus Muscle: A Case Report

Abstract

Heterotopic ossification (HO) is an ectopic formation of the lamellar bone in the soft tissues. Some authors have previously reported HO or calcific tendinitis of the peroneus longus tendon at the level of the cuboid bone, while the HO of the peroneus longus tendon in the retromalleolar portion has not been reported. The purpose of this report is to describe clinical, radiological, and histological features of this rare ossification and its treatment. To the best of our knowledge, this is the first report presenting a case of HO of the peroneus longus tendon, which developed in the retromalleolar portion.

Description and etiology of paleopathological lesions in the type specimen of Parasaurolophus walkeri (Dinosauria: Hadrosauridae), with proposed reconstructions of the nuchal ligament

“…It could have resulted from a direct blow or, alternatively, was a secondary injury attained because of the difficulties the individual had to endure after the traumatic event as it attempted to regain normal movement. An unusual increase of bone material can be a heterotopic ossification derived from a trauma (myositis ossificans traumatica; Chang et al, 2018; Davies et al, 2017; Kransdorf & Meis, 1993) or a tumoral growth following an injury (i.e., Uda et al, 2002; Urist, 1957). If we assume the abnormal morphology is related to an external trauma, it is possible the anterior region of the ilium might have suffered from the same impact as the thorax, or perhaps a second, separate knock.…”

“…Heterotopic ossification is defined as the formation of bone at atypical sites, in which ectopic lamellar bone forms within a tendon, muscle, or other soft tissue (Chang et al, 2018;Davies et al, 2017;Kransdorf & Meis, 1993). Myositis ossificans traumatica seems to explain the ossification of the discoidal overgrowth on the neural spine, as well as at the pubic peduncle of the ilium (given the absence of internal analysis).…”

Endoscopic Resection of Peroneus Quartus

“…1 The peroneus quartus is the most frequent aberrant muscle around the foot and ankle, with a reported incidence between 6.6% and 22%. [2][3][4] The frequent occurrence of this muscle in humans is suggestive of a progressive evolutionary change to evert the foot to assume a bipedal gait. 5,6 If present, the peroneus quartus passes as a slender tendon through the tunnel, posteromedial to the peroneus brevis tendon.…”

“…4 The presenting symptoms include chronic lateral ankle pain, clicking or snapping, peroneal tendon instability, or lateral ankle instability. 2,3,5,6,9,10 Besides the associated pathology, the peroneus quartus is of note because of its potential use to reconstruct the retromalleolar groove and to act as a strap to stabilize the peroneal tendons in case of recurrent peroneal tendon dislocation. 4,10 Surgical excision is a favorable treatment option for the symptomatic peroneus quartus muscle.…”

“…4,10 Surgical excision is a favorable treatment option for the symptomatic peroneus quartus muscle. 2,3 Peroneal tendoscopy has been suggested to detect the presence of the muscle and assess the associated pathology. 9 Endoscopic resection of the peroneus quartus has also been reported.…”