You are on page 1of 4

Clinical Anatomy 23:911–914 (2010

)

COMPENDIUM OF ANATOMICAL VARIANTS

An Anterior Fibulocalcaneus Muscle: An
Anomalous Muscle Discovered in the Anterior
Compartment of the Leg
H. WAYNE LAMBERT1,2* AND STAVROS ATSAS1,2
1
Department of Neurobiology and Anatomy, West Virginia University, Robert C. Byrd Health Sciences Center,
Morgantown, West Virginia
2
Department of Anatomical Sciences and Neurobiology, University of Louisville Health Sciences Center,
Louisville, Kentucky

Anomalous fibulocalcaneus muscles were discovered bilaterally in the anterior
compartment of the leg during a routine dissection of a 76-year-old Caucasian
male in the medical gross anatomy laboratory. These muscles originated from
the fibula, anterior crural septum, and the investing fascia of the fibularis
tertius, and they passed anterior to the lateral malleolus and inserted on the
calcaneus, anterosuperior to the fibular trochlea. To our knowledge, these
anterior fibulocalcaneus muscles have not been described previously. Clin.
Anat. 23:911–914, 2010. V 2010 Wiley-Liss, Inc.
C

Key words: anomalous muscle; anterior fibulocalcaneus; fibularis tertius;
peroneus quartus

INTRODUCTION lous leg muscles could also be used in reconstructive
procedures involving the lateral ankle joint (Tubbs et
Anomalous leg muscles associated with the lateral al., 2008); in fact, the superior fibular retinaculum
malleolus of the fibula have gained recent attention was reconstructed with a fibularis quartus tendon to
in the clinical literature. Within the lateral leg com- prevent acute anterior dislocation of the fibularis lon-
partment, a supernumerary muscle, the fibularis gus and brevis tendons following forced dorsiflexion
quartus, has also been shown to cause lateral ankle of the ankle (Mick and Lynch, 1987). Therefore,
pain, ankle instability, fibular tenosynovitis, subluxa- knowledge of anomalous muscles associated with
tion of the fibular (peroneal) tendons, and longitudi- the lateral malleolus is important because of associ-
nal splitting of the fibularis brevis tendon in radio- ated pathologies and potential surgical reconstruc-
logic and case studies (White et al., 1974; Regan tive procedures.
and Hughston, 1977; Wachter and Beekman, 1983; We describe an anomalous muscle originating in
Sobel et al., 1990; Buschmann et al., 1991; Sam- the anterior compartment of the leg coursing ante-
marco and Brainard, 1991; Cheung et al., 1997; rior to the lateral malleolus and inserting near the
Trono et al., 1999; Donley and Leyes, 2001; Marti- fibular (peroneal) trochlea of the calcaneus. This
nelli and Bernobi, 2002; Zammit and Singh, 2003). muscle has not been previously described in the
Surgical ablation of the fibularis quartus muscle of- medical literature.
ten resolved these clinical symptoms, though a spe-
cial treatment with othoses has also been reported
(Wachter and Beekman, 1983). Duplication of the
tendon of the fibularis brevis muscle and anomalous *Correspondence to: H. Wayne Lambert; West Virginia University
extension of the fibularis (peroneus) brevis and lon- Department of Neurobiology and Anatomy, Robert C. Byrd Health
gus muscles into the retromalleolar groove have also Sciences Center, HSN 4052, P.O. Box 9128, Morgantown, West
Virginia, USA 26506-9128. E-mail: wlambert@hsc.wvu.edu
been shown to elicit similar ankle pathologies, symp-
toms that suggest lateral ankle stenosis (Hammers- Received 1 September 2010; Accepted 7 September 2010
chlag and Goldner, 1989; Sobel et al., 1992; Abboud Published online 20 October 2010 in Wiley Online Library
and Okereke, 2008). The tendons of these anoma- (wileyonlinelibrary.com) DOI 10.1002/ca.21074

C 2010
V Wiley-Liss, Inc.

indicated by the scissors. Note the dupli- onstrated in the left leg. A: The insertion of the anomalous muscle. and the We observed bilateral anomalous muscles in the fascia covering the fibularis tertius muscle (Fig. anterior compartment of both legs during a routine The muscle was 33 cm long and averaged *15 mm dissection of a 76-year-old Caucasian male in the wide and 2 mm thick. the lateral malleolus and inserted distally on the cal- Fig. muscle is located anterior to the lateral malleolus in the anterior fibulocalcaneus. the anterior fibulocalcaneus. This muscle passed anterior to medical gross anatomy laboratory. 1. 1). the proximal one-third of the fibula. close relationship to the fibularis tertius. 2. REPORT OF THE CASE the muscle originated from the anterior crural sep- tum. On the left leg. The origin of the anomalous muscle. Fig. B: The anterior fibulocalcaneus cated fibularis tertius tendon. into the calcaneus is dem. . is shown in relation to the other muscles of the anterior compartment of the right leg.912 Lambert et al.

Goldner JL. Campbell and Dr. Rourke et al.. Sarrafian. peroneus muscle has been shown to cause posterior ankle pain quartus and the flexor digitorum longus accessorius. such as the ACKNOWLEDGMENTS fibulocalcaneus internus and externus. 1875. 2008. Jahss MH. Okereke E. in the fibular synovial sheath posterior to the fibula. The anomalous as the head. 1996. The fibulocalcaneus internus (of with the dissection and measurements. 2A). cle was *41 cm long and *15 mm wide and 2 mm We were unaware of a fibulocalcaneus muscle in thick.. a comparable muscle was these muscles.. respec. Seipel et al. Cheung YY. Chronic peroneal tendon sub- resided in the anterior leg compartment. Rosenberg ZS. Assist Tomogr 34:270–272. Jahss MH. 2006). Chronic lateral ankle pain secondary medial malleolus. 2010). Mel. Radiology determined to be a variant of the fibularis quartus 202:745–750. Stephen Nettle- lado et al. G. Athavale SA. coursed distally 9:465–473. Doubling of the muscular belly and tendon of anterior fibulocalcaneus muscle. Jungers et al. J hominoids and coincides with bipedal locomotion Hum Evol 25:377–386. Magnetic resonance di- retrotrochlear eminence of the calcaneus (Sobel et agnosis of tarsal tunnel syndrome due to flexor digitorum acces- al. Clin Anat 20:998– terior and lateral compartments of the leg. 2005. calcaneus muscle is the fibulocalcaneus externus. we propose naming it the mm.. 1997. 1991. It arises from the inner aspect of the lower one-third of the fibula distal to the origin of the flexor hallucis REFERENCES longus (FHL) muscle. 2005. evolution and that the more proximal the insertion of On the right leg. Joshi SD. Bruce was originally noted by Meckel in 1815 and further Palmer prepared the photos for the manuscript. and inserts Best A. Raheja et al. 2004. the anterior crural septum. with investing fascia of the fibularis tertius. ture suggests that the fibularis tertius is a young Jungers WL. 999. The functional and evolu- structure phylogenetically. Near its insertion.. sorius longus and peroneocalcaneus internus muscles. Ferrell R. Sei. Gumusalan Y. 2001. Sullivan M. and passed their proximal attachment in the vicinity of the fibular anterior to the lateral malleolus (Fig. 2007). 1997. Krueger WA. Chaney et al. helped pel et al. descends within the calcaneal to an anomalous peroneus longus. 2007.. 1923. muscles: Musculus fibulocalcaneus externum. ton served as co-authors on this case report. Raheja et al. 2B). 1872.. Study of ten anatomical variants of the foot and and Bui-Mansfield. 12:109–116. 2010. which appears in man and tionary significance of the human peroneus tertius muscle. Radiologists and insertion of the fibularis tertius was also noted on clinicians should be aware of this muscle when the right leg of this specimen (Fig. 1872. 1997. embarking in diagnosis and imaging interpretation. Anat Rec has been documented previously in approximately 1– 26:79–82. and reviewed MacAlister). however. but later 1997. Mellado et al. Mandrachhia VJ.. 1974. Donley BG. described by MacAlister in 1872 (Sarrafian. 2001. may support this theory.. Cheung et al. Buschmann WR.. Ramsinghani R. J Bone Joint Surg Am 87:2075–2079. Earl Ekstrom and Mr. 1993). It travels posterior to the Abboud JA. Foot Ankle 10:45–47. 1990. Morphology of peroneus ter- Stevens et al. The presence of a fibulocalcaneus internus imaging of anomalous leg muscles: Accessory soleus. 1993. A report of four the calcaneus (MacAlister. 1989. trochlea of the calcaneus. Cheung and Rosenberg. Mr.. Duran-Stanton AM. Anterior Fibulocalcaneus Muscle 913 caneus. The anomalous muscle described in this study Hammerschlag WA. 1993). 2007). have been documented in the literature (MacAlister.. Best et al. and inserted into the of chronic lateral ankle pain. J Comput Zammit and Singh. ular muscles to tarsal bones is a progressive step in neus (Fig. Another anomalous fibulo- ankle. 2005). and the fibulocalcaneus muscles discovered in this study. Linklater J. Cheung Y. which was described by Otto in 1816. 2006. Magnetic resonance 2005). Meldrum DJ. 2003.. 1993. . Werneck. Leyes M. DISCUSSION Anomalous fibulocalcaneal muscles. Lee MS. 2001. slip that attached to the capsule of the talocrural 1993. MR imaging of the accessory nated from the lower one-third of the fibula or the muscles around the ankle. A variation of fibularis quartus neus externus. Am J Sports Med 29:373–375. also called the fibulocalcaneus medialis. especially when chronic ankle pain is localized ante- rior to the lateral malleolus. 1957. Ozbag D. This mus. J Am Podiatr Med Assoc 86:532–537. Giza E. Magn Reson Imaging Clin N Am belly of the fibularis brevis muscle. Study on the peroneus of the tarsus. 2B). Joshi SS. Rosenberg ZS.. 1996. 2004). Peroneus quartus muscle: MR imaging features. muscle (Sobel et al. Hecker P. The tendon was 18 mm wide as it inserted (1923) suggested that the proximal attachment of fib- anterosuperior to the fibular trochlea of the calca. Beltran J. Am J Orthop 37:E182–E185. Clin Anat 19:611–614. the more evolved the specimen observed originating from the fibula as far proximal (Hecker. The litera. The tendon’s width at insertion was 15 this anomalous muscle. 1923. tively. 2001. On the basis of the origin and insertion of calcaneus. 2005) and tarsal tunnel syndrome (Duran-Stanton Chaney DM. groove lateral to the tendon of the FHL. cases. Foot Ankle and impingement (Seipel et al. Posterior impingement into the inferior surface of the sustentaculum tali of of the ankle caused by anomalous muscles. 1990. luxation produced by an anomalous peroneus brevis: Case Doubling of the fibularis tertius tendon (Fig. Stern JT. 2B) report and literature review. Gumusalan and Ozbag. the tendon also gave off a (Sokolowska-Pituchowa et al. Peroneus quartus muscle: A rare cause ris longus and brevis tendons. tius muscle. Bui-Mansfield LT. Khan MA.. It origi. Joshi et al.. Cheung and Rosenberg. Hecker joint. Yoho RM. are constituents of the pos. The distal attachment of this muscle was also the anterior compartment of the leg prior to our dis- located anterosuperior to the fibular trochlea of the covery. Cheung Y. Dr.. 2% of specimens (MacAlister. the paper critically. The fibulocalcaneus internus and fibulocalca.

Anat- Sobel M. Anatomy of the Foot and Ankle: Descriptive. Dafydd H. fibularis tertius em brancos. Surg Radiol Anat 27:158–160. 1977. Foot pain. Fibularis tertius: Revisiting Wachter S. Trans R Irish Acad 25:125–130. Tuli A. 2005. May WR. com pesquisa in vivo da presenca de seu tendao. Anat Sci Int 83:280– anomalous peroneal tendon. The peroneocalca. Topo. Pitsis G. 1990. Parkin IG. 1974. Colon E. 1957. 282. Arnoczky SP. The peroneo. Singh D. Anais Fac Sarrafian SK. Philadelphia: JB Lippincott Co. Zammit J. A case report. Brainard BJ. Med Univ Minas Gerais 17:417–520. Miaskiewicz C. 2004. calcaneus internus muscle: MR imaging features. Linklater J. Tubbs RS. Lynch F. Johnson D. Beltran J. Mellado JM. J Am Podiatry Assoc 73:523–524. 1993. omy and clinical relevance. Peroneotalocalcaneus muscle. Griswold DM. associated with the peroneus accessorius. Peroneus quartus muscle and ankle nism. A cadaveric study of the peroneus using peroneus quartus. Platt A. Libotte M. 1991. Levy ME. negros e mula- Am 73:131–133. Chronic ankle ‘‘sprain’’ secondary to 2008. Additional observations on muscular anomalies Sobel M. technique of diagnosis. Werneck HJL. Ankle 13:413–422. 2nd Ed. Sokolowska-Pituchowa J. Foot Ankle Int 8:223–225. Sullivan M. 1983. J Bone Joint Surg Am tertius muscle. Chronic ankle pain Seipel R. Bernobi S. Baillon J. Tueche S. J Bone Joint Surg morfologicos do M. Hughston JC. dynamics of peroneus brevis tendon splits: A proposed mecha- Martinelli B. 1974. Clin Orthop Relat Res neus internus muscle: An unusual cause of posterior ankle 103:53–55. 1992. tos. Folia Morphol (Warsz) 33:91–103. 1999. fibulares in a foot. 1987. Clin Orthop Relat Res 123:54–54. Skawina A. Bohne WH. Peroneus quartus: A case report. Shoja MM. Foot cal description of combined variation of distal attachments of Ankle Int 20:659–662. 69:296–297. Reconstruction of the peroneal retinaculum Stevens K. The in human anatomy. quartus muscle: A case report and review of the literature. Peroneus Raheja S. Foot Ankle 11:81–89. Choudhry R. Loukas M. Morphologi. Kumar H. Quintart C. Contribuicao para o estudo de alguns aspectos neus brevis in a high-jumper: A case report. graphic. Clin Anat 6:106–110. Macalister A. 2007. muscle in man. Olson EJ. Trono M. Geppert MJ. Regan TP. Congenital variations of the per. 1993. Makos K. impingement. Rourke K. J Bone Joint Surg Br 85:1134– oneus quartus muscle: An anatomic study. Ellis H. A symptomatic anomalous pero. Sammarco GJ. Rosenberg ZS. 1137. Functional. 2003. Bohne WH. The peroneus quartus muscle. 1997. AJR Am J Morphology and some measurements of the peroneus tertius Roentgenol 169:585–588. Singh P. Foot Ankle Int 26:890–893. White AA III. Clin Anat 20:946–949. the anatomy.914 Lambert et al. 2002. and classification of injury. Mick CA. p 235. Salter EG. 1872. Oakes WJ. . Beekman S.