Abstract
Objective. Quantify the presence of the fibularis quartus muscle and correlate it with the individual's sex and concomitant presence of the fibularis tertius muscle. Materials and Methods. We evaluated 211 magnetic resonance examinations (43.13% men and 56.87% women) on the ankle and hindfoot, produced between 2009 and 2011. Results. The fourth fibularis muscle was found to be present in 7.62% of the examinations and 75% of these also contained the fibularis tertius muscle. Conclusion. The incidence of the fourth fibularis muscle is variable; moreover, its incidence does not depend on the individual's gender or the presence of the fibularis tertius muscle.
Highlights
The fibularis quartus muscle was first described by Otto in 1816 [1] and was subsequently studied in detail by Hecker in 1923 [2]
The presence of the fibularis quartus muscle may simulate a longitudinal tear in the fibularis brevis tendon, but is differentiated by the presence of the muscle, when a muscle belly separated from the muscle belly of the fibularis brevis is present [8]
The fibularis quartus muscle was observed in 16 ankles (7.62%) (Figures 1, 2, and 3), seven women (43.75%) and 9 male (56.25%) (Table 1)
Summary
The fibularis quartus muscle was first described by Otto in 1816 [1] and was subsequently studied in detail by Hecker in 1923 [2]. Its insertion is variable, explaining the variety of names that it has received: accessory fibularis muscle (insertion into the tendon of the fibularis longus, in the sole of the foot); fibulocalcaneus muscle (insertion into the retrotrochlear eminence); fibulocuboid muscle (insertion into the tuberosity of the cuboid bone, inferiorly); or fibular-fibularis longus muscle (insertion into the tendon of the fibularis longus muscle or into the inferior retinaculum of the fibularis muscles, adjacent to the retrotrochlear eminence) These last two variants are the ones with lowest incidence [6, 9, 10]. The fibularis quartus muscle acts predominantly as a pronator for the foot, as do the other fibularis muscles (longus and brevis) It has been successfully used in surgical procedures to repair and reconstruct the retinaculum of the fibularis muscles, in treating subluxation of the tendons of the fibularis muscles [6, 11]
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