Peroneus Tertius Research Articles

Anomalous Pattern of Tendinous Slips of Peroneus Tertius and Extensor Digitorum Longus Muscles in the Foot- A Clinically Important Variation

The peroneus tertius (PT) is a small muscle with a small single tendon which gets inserted to the dorsal surface of the 5th metatarsal base. Normally, the tendon of extensor digitorum longus (EDL) muscle divides into 4 slips on the dorsum of the foot which go to the lateral 4 toes. Variations in the tendons of these muscles are very rare. We observed a case where the tendon of EDL divided into only 3 slips which were inserted into the 2nd, 3rd and 4th toes through dorsal digital expansion. The PT tendon was quite thick and it divided into 2 slips. The lateral slip was getting inserted to the dorsal surface of the 5th metatarsal base and medial slip was continuing on to the little toe to form the dorsal digital expansion. This variation was observed during routine dissection on the left lower limb of about 55 year old female cadaver. Such anomalies are important clinically to the treating surgeon, being a tendon of importance in normal function and surgeries of the foot. Functional significance and the clinical relevance of the variations are discussed.

Plantar Rupture of Peroneus Longus Tendon Associated to Os Peroneum Fracture: A New Method of Treatment

We report a case of plantar rupture of peroneus longus tendon with fracture of the os peroneum after a minor trauma. This is a rare pathology and several treatment optionshave been proposed in the literature. We describe a new way of treatment consisting in subperiosteal excision of the proximal fractured os peroneum and side-to-side repair with augmentation with the peroneus tertius if present

Bases anatômicas para utilização do músculo fibular terceiro em retalhos miocutâneos

INTRODUCAO: A utilizacao de retalhos miocutâneos e cada dia mais frequente nas cirurgias plasticas reconstrutoras de membros inferiores, tornando-se essencial a utilizacao de musculos que denotem menor prejuizo tanto funcional como estetico. Foram estudados a frequencia e os aspectos anatomicos do musculo fibular terceiro, com o intuito de avaliar, sob esses aspectos, a possibilidade de seu uso nesses procedimentos. METODO: Foram dissecados 64 membros inferiores de cadaveres fixados e verificadas as seguintes caracteristicas: insercao proximal, insercao distal, sintopia, morfologia e morfometria. RESULTADOS: A presenca do musculo foi constatada em 96,9% dos casos, sendo analisados os aspectos supracitados. A insercao proximal mais frequente (96,8%) ocorreu na membrana interossea, na margem anterior da fibula, e no septo intermuscular anterior. A insercao distal mais comum (77,4%) foi nas faces dorsal e lateral do 5o metatarsiano. O valor medio do comprimento e da largura do ventre muscular foi, respectivamente, de 17,89 cm e 1,95 cm, enquanto a media do comprimento do tendao distal livre de fibras musculares foi de 1,2 cm e a largura media do tendao distal, de 0,45 cm. CONCLUSOES: O musculo fibular terceiro e frequente, de morfologia distinta, que, sob aspectos morfometricos, se constitui em opcao viavel para um estudo mais especifico de seu uso no reparo de defeitos no segmento distal do membro inferior.

Proximity of Arthroscopic Ankle Stabilization Procedures to Surrounding Structures: An Anatomic Study

To examine the anatomy of the lateral ankle after arthroscopic repair of the lateral ligament complex (anterior talofibular ligament [ATFL] and calcaneofibular ligament [CFL]) with regard to structures at risk. Ten lower extremity cadaveric specimens were obtained and were screened for gross anatomic defects and pre-existing ankle laxity. The ATFL and CFL were sectioned from the fibula by an open technique. Standard anterolateral and anteromedial arthroscopy portals were made. An additional portal was created 2 cm distal to the anterolateral portal. The articular surface of the fibula was identified, and the ATFL and CFL were freed from the superficial and deeper tissues. Suture anchors were placed in the fibula at the ATFL and CFL origins and were used to repair the origin of the lateral collateral structures. The distance from the suture knot to several local anatomic structures was measured. Measurements were taken by 2 separate observers, and the results were averaged. Several anatomic structures lie in close proximity to the ATFL and CFL sutures. The ATFL sutures entrapped 9 of 55 structures, and no anatomic structures were inadvertently entrapped by the CFL sutures. The proximity of the peroneus tertius and the extensor tendons to the ATFL makes them at highest risk of entrapment, but the proximity of the intermediate branch of the superficial peroneal nerve (when present) is a risk with significant morbidity. Our results indicate that the peroneus tertius and extensor tendons have the highest risk for entrapment and show the smallest mean distances from the anchor knot to the identified structure. Careful attention to these structures, as well as the superficial peroneal nerve, is mandatory to prevent entrapment of tendons and nerves when one is attempting arthroscopic lateral ankle ligament reconstruction. Defining the anatomic location and proximity of the intervening structures adjacent to the lateral ligament complex of the ankle may help clarify the anatomic safe zone through which arthroscopic repair of the lateral ligament complex can be safely performed.

The Use of a Bone-Anchored Device as a Hard-Wired Conduit for Transmitting EMG Signals From Implanted Muscle Electrodes

The use of a bone-anchored device to transmit electrical signals from internalized muscle electrodes was studied in a sheep model. The bone-anchored device was used as a conduit for the passage of a wire connecting an internal epimysial electrode to an external signal-recording device. The bone-anchored device was inserted into an intact tibia and the electrode attached to the adjacent M. peroneus tertius. "Physiological" signals with low signal-to-noise ratios were successfully obtained over a 12-week period by walking the sheep on a treadmill. Reliable transmission of multiple muscle signals across the skin barrier is essential for providing intuitive, biomimetic upper limb prostheses. This technology has the potential to provide a better functional and reliable solution for upper limb amputee rehabilitation: attachment and control.

Assessment of electromyograghic findings in peroneus tertius, tibialis posterior and dorsal interoseous pedis muscles in patients with axonal polyneuropathy

Background:Axonal polyneuropathy (APN) is a common kind of neurologic disorders, which is normally diagnosed by electrodiagnostic methods. Different muscles were studied to find a muscle, which can be considered as a reliable site for early diagnosis of mild APN; this muscle should be easily activated by patient, has the highest sensitivity to EMG changes of APN, and has the lowest rate of false positive results in normal subjects.Materials and Methods:Based on the inclusion and exclusion criteria, 32 patients were recruited, and all of them underwent needle EMG of 3 different muscles including Peroneus tertius (PT), tibialis posterior (TP), and dorsal interoseous pedis (DIP). EMG Findings of different muscles [Motor Unite Action Potential (MUAP) duration, MUAP amplitude, polyphasic MUAP, fibrillation potential (FP), and the ability of subjects to contract special muscle] were recorded and compared.Results:Mean of MUAP amplitude was significantly different between all 3 muscles (P-values < 0.001). PT showed a significantly higher frequency of polyphasic MUAP than others (P-value: 0.001). The frequency of FP was significantly lower in TP than PT and DIP (P-values: 0.03 and 0.001, respectively). DIP showed significantly shorter MUAP duration than PT and TP (P-values 0.002 and 0.003, respectively). All cases were able to activate TP and PT voluntarily though only 20 patients could activate DIP (P-value < 0.0001).Conclusion:The higher frequency of polyphasic MUAP, the higher frequency of FP, and finally, the ability of all patients in activation of PT voluntarily, all support the usefulness of PT for EMG studies in APN patients.

Surface anatomy and prevalence of fibularis tertius muscle in a south-western Nigerian population

Fibularis tertius is a variant muscle of the leg that inserts in the foot. It has been implicated in providing clues to the evolution of upright posture in man. This work investigates the prevalence of fibularis tertius muscle in the African population, using south-western Nigeria as a sample population. The percentage prevalence of fibularis tertius muscle in the population studied is 63%, with higher prevalence in males compared to females. The muscle was however observed to present itself more on the right limb than on the left. Fifteen percent (15%) of the subjects had fibularis tertius muscle only on the right foot. Six percent (6%) had the muscle on the left foot only, 52% had it on both feet and 27% did not have the muscle on any of their foot. A unique surface positioning of the fibularis ter-tius tendon was also observed in all the subjectsstudied. These findings may provide contributions to the clinical evaluation of the muscle.

Analysis on the Incidence of the Fibularis Quartus Muscle Using Magnetic Resonance Imaging

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.

Distribuição do nervo fibular comum em fetos de equinos e descrição anatômica de pontos para bloqueio anestésico

Analisou-se a distribuição do nervo fibular comum em 30 fetos de equinos, sem raça definida, provenientes do acervo do Laboratório de Anatomia Animal da Faculdade de Medicina Veterinária da Universidade Federal de Uberlândia, que foram injetados e conservados em solução aquosa de formaldeído a 10%. Contatou-se que o referido nervo deriva do isquiático, divide-se em nervos fibulares superficial e profundo, distribuindo-se para os músculos extensores lateral e longo do dedo, fibular terceiro e tibial cranial. Traçando-se uma linha imaginária na região médio-lateral da tuberosidade do osso tíbia, o nervo fibular comum pode ser bloqueado em sua parte proximal, no terço caudal, entre o tendão de inserção do músculo bíceps femoral e a face lateral do músculo gastrocnêmio lateral (terço médio); e o nervo fibular profundo, na parte proximal da tíbia, crânio-distalmente ao fibular comum. O bloqueio do nervo fibular superficial pode ser realizado em duas regiões da tíbia: na proximal, considerando-se a linha imaginária, distalmente ao ponto citado para o fibular comum e caudalmente ao descrito para o fibular profundo; e na distal, na face lateral da articulação tíbio-társica, entre os tendões de inserção dos músculos extensores lateral e longo do dedo.

Arthroscopic Approach to the Subextensorius Recess of the Lateral Femorotibial Joint of the Foal

To (1) develop an arthroscopic approach to the subextensorius recess of the lateral femorotibial (LFT) joint in foals and (2) report its use in foals with LFT joint sepsis. (1) Anatomic study and (2) retrospective case series. (1) Cadaveric hind limbs (n = 32 foals) to delineate the anatomy of the subextensorius recess; 13 foal limbs for cadaver surgery to assess the approach to the subextensorius recess; and (2) foals (n = 8) with LFT joint sepsis. (1) The LFT joint was distended and examined ultrasonographically. Dissection was used to document periarticular landmarks, potential distal arthroscopic portals, and assess iatrogenic damage after cadaveric surgery. (2) Retrieval of data from 8 foals with LFT joint sepsis treated using the arthroscopic approach. (1) The optimal arthroscopic approach to the distal subextensorius recess is craniolaterally, 8-10 cm distal to the tibial plateau, immediately caudal to the peroneus tertius muscle, through the long digital extensor muscle belly, entering the distal extent of the subextensorius recess. Thirteen limbs dissected after cadaver surgery had no iatrogenic damage to the peroneus tertius muscle or peroneal nerve. (2) Two foals were euthanized. Resolution of sepsis occurred in 6 foals, and all were sound at follow-up >9 months after surgery. The subextensorius recess may be safely accessed arthroscopically in foals.

Case Report: Simultaneous rupture of the fibularis tertius and subluxation of the proximal intertarsal joint of a horse

Case report: Simultaneous rupture of the fibularis tertius and subluxation of the proximal intertarsal joint of a horse. This case report describes the successful management of a horse with simultaneous rupture of the fibularis tertius and subluxation of the proximal intertarsal joint. The objective of the report is to highlight that successful management of these injuries can be achieved with conservative therapy in suitable horses.

Acute compartment syndrome in the pelvic limb of a cow following biopsy of a skeletal muscle-associated hemangiosarcoma

A 6-year-old Holstein cow was examined because of chronic lameness and swelling near the stifle joint of the left pelvic limb. A mass was palpated in the soft tissues lateral to the proximal aspect of the left tibia. Multiple attempts to obtain a biopsy specimen of the mass resulted in acute compartment syndrome of the femoral compartment (tensor fasciae latae and biceps femoris muscles) and lateral tibial compartment (cranial tibial and peroneus tertius muscles) with associated sciatic nerve paralysis. Surgical decompression via tensor fasciae latae and biceps femoris incision resolved the sciatic nerve paralysis. On the fifth day following surgery, the cow began to develop signs of increased respiratory effort. Thoracic radiography revealed a pulmonary metastatic micronodular pattern. The cow was euthanized because its condition deteriorated. Metastatic hemangiosarcoma was confirmed at necropsy, and the primary tumor was the mass that was lateral to the tibia and within the biceps femoris muscle. Hemangiosarcoma should be considered a differential diagnosis for lameness in cattle when no orthopedic cause can be identified. Close patient surveillance is strongly recommended in the event that a vascular tumor is present because catastrophic consequences are possible. To our knowledge, this is the first report of acute compartment syndrome in a pelvic limb of a bovine patient and the only report of hemangiosarcoma in the skeletal muscle of cattle.

A study of the anatomy and injection techniques of the ovine stifle by positive contrast arthrography, computed tomography arthrography and gross anatomical dissection

Although ovine stifle models are commonly used to study osteoarthritis, meniscal pathology and cruciate ligament injuries and repair, there is little information about the anatomy of the joint or techniques for synovial injections. The objectives of this study were to improve anatomical knowledge of the synovial cavities of the ovine knee and to compare intra-articular injection techniques. Synovial cavities of 24 cadaver hind limbs from 12 adult sheep were investigated by intra-articular resin, positive-contrast arthrography, computed tomography (CT) arthrography and gross anatomical dissection. Communication between femoro-patellar, medial femoro-tibial and lateral femoro-tibial compartments occurred in all cases. The knee joint should be considered as one synovial structure with three communicating compartments. Several unreported features were observed, including a communication between the medial femoro-tibial and lateral femoro-tibial compartments and a latero-caudal recess of the lateral femoro-tibial compartment. No intermeniscal ligament was identified. CT was able to define many anatomical features of the stifle, including the anatomy of the tendinous synovial recess on the lateral aspect of the proximal tibia under the combined tendon of the peroneus tertius, extensor longus digitorum and extensor digiti III proprius. An approach for intra-articular injection into this recess (the subtendinous technique) was assessed and compared with the retropatellar and paraligamentous techniques. All three injection procedures were equally successful, but the subtendinous technique appeared to be most appropriate for synoviocentesis and for injections in therapeutic research protocols with less risk of damaging the articular cartilage.

An unique variation of the peroneus tertius muscle

Peroneus tertius (fibularis tertius) is a muscle unique to humans. It often appears to be a part of extensor digitorum longus, and might be described as its "fifth tendon". Although its insertion variation has been reported by many authors, variations of its origin points are not common. A variation of the peroneus tertius muscle was found during routine dissection of a 75-year-old male cadaver. The muscle originated from the extensor hallucis longus. The muscle belly of the extensor hallucis longus arose from the middle two-fourths of the medial surface of the fibula, medial to the extensor digitorum longus, and anterior surface of the interosseous membrane. It lay under the extensor digitorum longus, and lateral to the tibialis anterior muscle. The muscle belly of the extensor hallucis longus divided into medial and lateral parts 17 cm below its origin point. The lateral part, named as peroneus tertius, continued downward to reach the medial part of the dorsal surface of the base of the fifth metatarsal bone. The medial part ran also downward and divided into two tendons reaching the dorsal surface of the base of the distal phalanx of the great toe. This kind of variation may be important during foot or leg surgery.

Comparison of cross-sectional anatomy and computed tomography of the tarsus in horses

To compare computed tomography (CT) images of equine tarsi with cross-sectional anatomic slices and evaluate the potential of CT for imaging pathological tarsal changes in horses. 6 anatomically normal equine cadaveric hind limbs and 4 tarsi with pathological changes. Precontrast CT was performed on 3 equine tarsi; sagittal and dorsal reconstructions were made. In all limbs, postcontrast CT was performed after intra-articular contrast medium injection of the tarsocrural, centrodistal, and tarsometatarsal joints. Images were matched with corresponding anatomic slices. Four tarsi with pathological changes underwent CT examination. The tibia, talus, calcaneus, and central, fused first and second, third, and fourth tarsal bones were clearly visualized as well as the long digital extensor, superficial digital flexor, lateral digital flexor (with tarsal flexor retinaculum), gastrocnemius, peroneus tertius, and tibialis cranialis tendons and the long plantar ligament. The lateral digital extensor, medial digital flexor, split peroneus tertius, and tibialis cranialis tendons and collateral ligaments could be located but not always clearly identified. Some small tarsal ligaments were identifiable, including plantar, medial, interosseus, and lateral talocalcaneal ligaments; interosseus talocentral, centrodistal, and tarsometatarsal ligaments; proximal and distal plantar ligaments; and talometatarsal ligament. Parts of the articular cartilage could be assessed on postcontrast images. Lesions were detected in the 4 tarsi with pathological changes. CT of the tarsus is recommended when radiography and ultrasonography are inconclusive and during preoperative planning for treatment of complex fractures. Images from this study can serve as a CT reference, and CT of pathological changes was useful.

Is the Anterior Tibial Artery Safe During Ankle Arthroscopy?

Background: Pseudoaneurysm of the anterior tibial artery (ATA) after ankle arthroscopy is an uncommon complication but can cause unexpected consequences. However, its contributing factor is not fully understood. Hypothesis: Anatomic factors, such as ATA variations and the distance between the ATA and joint capsule, may contribute to the occurrence of pseudoaneurysm. Study Design: Case series; Level of evidence, 4. Methods: The magnetic resonance images and medical records of 358 ankle cases were analyzed. According to locations of the ATA in relation to the peroneus tertius (PT) and the extensor digitorum longus (EDL) tendon on axial magnetic resonance imaging, patients were classified as type 1 (safe type), type 2 (increased risk type), or type 3 (high-risk type). In addition, distances between the anterior joint capsule and the ATA were measured to evaluate the thickness of the anterior fat pad, which contains the ATA and anterior compartment tendons. Results: In 336 cases (93.8%), the ATA was located medial to the EDL (type 1, safe). In 7 cases (2.0%), the ATA was located lateral to the EDL and PT tendon (type 2, increased risk); and in 15 cases (4.2%), the branching artery was observed lateral to the EDL and PT tendon and the ATA was in the normal position (type 3, high risk). The mean distance between the anterior joint capsule and the ATA was 2.3 ± 1.1 mm. Conclusion: In 22 (6.2%) of the 358 cases, the ATA and its branches were located near the anterolateral ankle portal, which introduces the risk of vascular damage during arthroscopic surgery. Furthermore, the mean distance between the ATA and the joint capsule was only 2.3 ± 1.1 mm, and thus the ATA is very close to the anterior working space of the ankle joint. Careful preoperative evaluation and an intra-articular procedure may reduce the risk of vascular complications attributable to ankle arthroscopy.

Surgical Resolution of an Avulsion Fracture of the Peroneus Tertius Origin in a Giraffe (Giraffa camelopardalis reticulata)

A 4-mo-old, 185-kg male giraffe (Giraffa camelopardalis reticulata) was presented due to stifle effusion and lameness of 3-wk duration. Radiographs revealed a fracture of the extensor fossa of the lateral trochlear ridge of the femur at the origin of the peroneus tertius. Under anesthesia, dysfunction of the reciprocal apparatus was documented by flexing the stifle while the tarsus remained extended. An avulsion fracture of the origin of the peroneus tertius and extensor digitorum longus muscle was diagnosed. An exploratory arthroscopy of the femorotibial joint was followed by arthrotomy to excise the large bone fragment from its soft tissue attachments. Because of the fractious temperament of the animal, postoperative care was restricted to stall rest for 3 mo, and no postoperative complications arose. Only a mild residual lameness remained by 6 mo after surgery.

Computed tomographic anatomy of the equine stifle joint

To provide a detailed computed tomography (CT) reference of the anatomically normal equine stifle joint. Sample-16 hind limbs from 8 equine cadavers; no horses had evidence of orthopedic disease of the stifle joints. CT of the stifle joint was performed on 8 hind limbs. In all limbs, CT was also performed after intra-articular injection of 60 mL of contrast material (150 mg of iodine/mL) in the lateral and medial compartments of the femorotibial joint and 80 mL of contrast material in the femoropatellar joint (CT arthrography). Reformatted CT images in the transverse, parasagittal, and dorsal plane were matched with corresponding anatomic slices of the 8 remaining limbs. The femur, tibia, and patella were clearly visible. The patellar ligaments, common origin of the tendinous portions of the long digital extensor muscle and peroneus tertius muscle, collateral ligaments, tendinous portion of the popliteus muscle, and cranial and caudal cruciate ligaments could also be consistently evaluated. The cruciate ligaments and the meniscotibial ligaments could be completely assessed in the arthrogram sequences. Margins of the meniscofemoral ligament and the lateral and medial femoropatellar ligaments were difficult to visualize on the precontrast and postcontrast images. CT and CT arthrography were used to accurately identify and characterize osseous and soft tissue structures of the equine stifle joint. This technique may be of value when results from other diagnostic imaging techniques are inconclusive. The images provided will serve as a CT reference for the equine stifle joint.

Discovery of the anterior fibulocalcaneus muscle: an anomalous leg muscle

A novel muscle, the anterior fibulocalcaneus, has been discovered bilaterally in the anterior compartment of the leg in three separate cadaveric dissections. This muscle originates from the fibula, anterior crural septum, and the investing fascia of the fibularis tertius. Its tendon passes anterior to the lateral malleolus to insert onto the calcaneus, anterosuperior to the fibular trochlea. Anomalous fibulocalcaneal muscles associated with the lateral malleolus have been noted to cause a variety of ankle pathologies, and supernumerary muscles within the talocrural joint have been utilized for surgical reconstructive procedures. Radiologists and clinicians should be aware of this muscle when embarking in diagnosis and imaging interpretation, especially when chronic ankle pain is localized anterior to the lateral malleolus (Lambert and Atsas, 2010).

An anterior fibulocalcaneus muscle: An anomalous muscle discovered in the anterior compartment of the leg

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.