Morphological variations and accessory ossicles in the peroneal and tibialis muscles

Abstract

This study describes five bilateral anatomical variations in the feet of a 97-year-old male cadaver. Following routine dissection, all variants were measured and documented. Three accessory tendons and two accessory ossicles were identified. Bilateral accessory tendons were present from the tibialis anterior (type II), peroneus tertius (type III), and peroneus brevis muscles. Accessory tendon length was 36–104 mm and width was 1–3 mm each inserting more distally then the main tendon. Accessory ossicles were identified as an accessory navicular and os peroneum, respectively. Individually, each variation has varying prevalence rates in the literature, but to date, no known studies have been published describing the combined presence of all five bilateral variations. The acknowledgement of multi-variant cases such as this one may be helpful in the clinical setting, particularly for patients with pathology or for those undergoing foot and ankle surgery.

Concomitant variations of the tibialis anterior, and extensor hallucis longus, and extensor hallucis brevis muscles

“…In the anterior compartment of the leg, accessory tendons arising/splitting from a main tendon occur in 9%–22% of the population [ 5 ]. The prevalence of TA accessory tendons range from 20%–100% compared to 24%–42.5% for EHL bands [ 1 ].…”

Dimensions of pes anserinus of the lower extremity, an anatomical study with its surgical implications

“…The morphometric data about PA are scarce from the global literature. In the routine dissection teaching, the typical presentation of the musculature is always emphasized [ 16 ]. But there is a need for the knowledge about the variant anatomy of these muscles.…”

Os peroneo como causa de dolor lateral persistente de tobillo

“…Aunque estudios en cadáveres muestran un precursor del os peroneo en el periodo fetal, la incidencia de OP aumenta cada década de la vida un 10%, sugiriendo un origen biomecánico para la mayoría de OP 5 , por sobreutilización y/o alteraciones en la columna tobillo-pie, tipo pie cavo o varo, que generarían sobrecarga y fricción del TPL en el canal cuboide, inflamación y el desarrollo del OP y del POPS 3 .…”

“…La presentación crónica está relacionada con el proceso de curación de una fractura aguda, de una fractura por estrés asociada con traumatismo crónico repetitivo, o de una contusión que provoca necrosis avascular, con calcificación, remodelación y/o diástasis crónica del OP 1,2 . Pero también con una sobreutilización del TPL, asociada o no a alteraciones anatómicas o funcionales predisponentes (surco fibular poco profundo, retináculo peroneo inferior prominente, pie cavo-varo, alteraciones de la marcha que condicionen mal apoyo plantar en varo), o con tendinosis y tenosinovitis del TPL, o de otros tendones del tobillo que alteren la mecánica del movimiento 2,5,6 . El mal apoyo plantar en cavo, presente en los dos casos clínicos expuestos, podría ser una causa frecuente de POPS.…”