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DOI: 10.1055/s-0043-1762594
Imaging of Tendinous and Muscular Anatomical Variants Around the Ankle
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Abstract
Tendinous and muscular anatomical variants around the ankle are usually an unexpected finding on imaging. Magnetic resonance imaging offers the best visualization of the accessory muscles; however, they can also be detected on radiography, ultrasonography, and computed tomography. Their accurate identification facilitates appropriate management of the rare symptomatic cases, mostly caused by accessory muscles in the posteromedial compartment. Symptomatic patients present with chronic ankle pain, most commonly as tarsal tunnel syndrome. The most frequently observed accessory muscle around the ankle is the peroneus tertius muscle, an accessory muscle in the anterior compartment. The tibiocalcaneus internus and peroneocalcaneus internus are uncommon; anterior fibulocalcaneus is rarely mentioned. We describe the anatomy of the accessory muscles with their anatomical relations accompanied by schematic drawings and radiologic images from clinical practice.
Publication History
Article published online:
03 April 2023
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References
- 1 Aparisi Gómez MP, Aparisi F, Bartoloni A. et al. Anatomical variation in the ankle and foot: from incidental finding to inductor of pathology. Part I: ankle and hindfoot. Insights Imaging 2019; 10 (01) 74
- 2 Al-Himdani S, Talbot C, Kurdy N, Pillai A. Accessory muscles around the foot and ankle presenting as chronic undiagnosed pain. An illustrative case report and review of the literature. Foot 2013; 23 (04) 154-161
- 3 Cheung Y. Normal variants: accessory muscles about the ankle. Magn Reson Imaging Clin N Am 2017; 25 (01) 11-26
- 4 Van Hul E, Vanhoenacker F, Van Dyck P, De Schepper A, Parizel PM. Pseudotumoural soft tissue lesions of the foot and ankle: a pictorial review. Insights Imaging 2011; 2 (04) 439-452
- 5 Albano D, Dalili D, Huber FA, Snoj Z, Vieira A, Messina C. Young Club of the European Society of Musculoskeletal Radiology (ESSR). Current status of MSK radiology training: an international survey by the European Society of Musculoskeletal Radiology (ESSR). Young Club. Insights Imaging 2021; 12 (01) 126
- 6 Snoj Ž, Hebar T, Sconfienza LM. et al. Present status of musculoskeletal radiology in Europe: international survey by the European Society of Musculoskeletal Radiology. Semin Musculoskelet Radiol 2020; 24 (03) 323-330
- 7 Numkarunarunrote N, Malik A, Aguiar RO, Trudell DJ, Resnick D. Retinacula of the foot and ankle: MRI with anatomic correlation in cadavers. AJR Am J Roentgenol 2007; 188 (04) W348-54
- 8 Kiel J, Kaiser K. Tarsal Tunnel Syndrome. Treasure Island, FL: StatPearls; 2022
- 9 Rodríguez-Merchán EC, Moracia-Ochagavía I. Tarsal tunnel syndrome: current rationale, indications and results. EFORT Open Rev 2021; 6 (12) 1140-1147
- 10 Saar WE, Bell J. Accessory flexor digitorum longus presenting as tarsal tunnel syndrome: a case report. Foot Ankle Spec 2011; 4 (06) 379-382
- 11 Sookur PA, Naraghi AM, Bleakney RR, Jalan R, Chan O, White LM. Accessory muscles: anatomy, symptoms, and radiologic evaluation. Radiographics 2008; 28 (02) 481-499
- 12 Clemenshaw LTCMN, Bui-Mansfield LT. Accessory muscles of the ankle, how to recognize them on MRI, and their clinical relevance. Contemporary Diagnostic Radiology 2011; 34 (14) 1-7
- 13 LaVallee JR, Pourcho AM, Henning PT, Lambert HW. Sonographic identification of the flexor digitorum accessorius longus tendon. PM R 2018; 10 (03) 325-327
- 14 Mayer WP, Baptista JDS, Azeredo RA, Musso F. Accessory soleus muscle: a case report and clinical applicability. Autops Case Rep 2013; 3 (03) 5-9
- 15 Kendi TK, Erakar A, Oktay O, Yildiz HY, Saglik Y. Accessory soleus muscle. J Am Podiatr Med Assoc 2004; 94 (06) 587-589
- 16 Luck MD, Gordon AG, Blebea JS, Dalinka MK. High association between accessory soleus muscle and Achilles tendonopathy. Skeletal Radiol 2008; 37 (12) 1129-1133
- 17 Seipel R, Linklater J, Pitsis G, Sullivan M. The peroneocalcaneus internus muscle: an unusual cause of posterior ankle impingement. Foot Ankle Int 2005; 26 (10) 890-893
- 18 Howe BM, Murthy NS. An accessory peroneocalcaneus internus muscle with MRI and US correlation. J Radiol Case Rep 2012; 6 (10) 20-25
- 19 Lambert HW, Atsas S, Fox JN. The fibulocalcaneus (peroneocalcaneus) internus muscle of MacAlister: clinical and surgical implications. Clin Anat 2011; 24 (08) 1000-1004
- 20 Bilgili MG, Kaynak G, Botanlioğlu H. et al. Peroneus quartus: prevalence and clinical importance. Arch Orthop Trauma Surg 2014; 134 (04) 481-487
- 21 Donley BG, Leyes M. Peroneus quartus muscle. A rare cause of chronic lateral ankle pain. Am J Sports Med 2001; 29 (03) 373-375
- 22 Zammit J, Singh D. The peroneus quartus muscle. Anatomy and clinical relevance. J Bone Joint Surg Br 2003; 85 (08) 1134-1137
- 23 Yammine K, Erić M. The fibularis (peroneus) tertius muscle in humans: a meta-analysis of anatomical studies with clinical and evolutionary implications. BioMed Res Int 2017; 2017: 6021707
- 24 Iceman K, Magnus MK, Thompson MJ, Abicht BP. Peroneus tertius syndrome: a rare cause of anterolateral ankle and rearfoot pain. J Foot Ankle Surg 2020; 59 (01) 131-135
- 25 Upadhyay B, Amiras D. MRI appearances of the anterior fibulocalcaneus muscle: a rare anterior compartment muscle. Skeletal Radiol 2015; 44 (05) 723-726