1. bookVolume 12 (2018): Issue 3 (June 2018)
Journal Details
License
Format
Journal
eISSN
1875-855X
First Published
01 Jun 2007
Publication timeframe
6 times per year
Languages
English
access type Open Access

Unusual accessory peroneal muscles, peroneus quartus, peroneus digiti quinti, and their association with peroneus brevis tendon tear

Published Online: 20 Sep 2019
Volume & Issue: Volume 12 (2018) - Issue 3 (June 2018)
Page range: 125 - 130
Journal Details
License
Format
Journal
eISSN
1875-855X
First Published
01 Jun 2007
Publication timeframe
6 times per year
Languages
English
AbstractBackground

Anatomic variation and supernumerary contents in the superior peroneal tunnel, and the prominence of the retrotrochlear eminence and peroneal tubercle are related to peroneal tendon disorders.

Objectives

To investigate the prevalence, origin, and insertion of accessory peroneal muscles, the prominence of the retrotrochlear eminence and peroneal tubercle, and their association with peroneal tendon tears.

Methods

We examined 109 formalin-embalmed legs of cadavers from Thai donors. Accessory peroneal muscles and peroneal tendon tears were noted. Associations with peroneal tendon tears were evaluated using a χ2 test.

Results

We found 48 accessory peroneal muscles comprising 13 peroneus quartus (PQ), 33 peroneus digiti quinti (PDQ), and 2 unusual muscles. All PDQ originated from the PB tendon and inserted on various parts of the 5th toe. The PQ originated mostly from the PB muscle belly and less from the tendinous part with various insertions on the retrotrochlear eminence, peroneal tubercle, cuboid, and dorsolateral surface of the 5th metatarsal base. Two unusual accessory muscles were identified, 1 coexisting with the PQ. A PB tendon tear was found in 13% of specimens. We found no association between the peroneal tendon tears and the accessory peroneal muscles, or prominence of the retrotrochlear eminence or peroneal tubercle.

Conclusions

The prevalence of PQ, PDQ, and unusual accessory peroneal muscles was concordant with previous findings. We noted a new type of unusual accessory peroneal muscle coexisting with the PQ. No association was found between peroneal tendon tears and the PQ, PDQ, or prominence of the retrotrochlear eminence or peroneal tubercle.

Keywords

There are various types of peroneal tendon injuries including tear, subluxation, and dislocation of peroneus brevis (PB) and peroneus longus (PL) tendons [1, 2, 3]. These injuries decrease performance in walking, running, and sport [1, 4, 5, 6].

The pathomechanics of peroneal tendon tear are related to an immediate eccentric contraction in dorsiflexion, while the foot is in contact with the ground. The mechanism of the injury is similar to that for lateral ankle sprain [7, 8].

Therefore, only 60% of the patients with peroneal tendon injuries are correctly diagnosed when first evaluated [9, 10]. There are several factors associated with peroneal tendon disorders, in particular anatomic variation and supernumerary contents of the superior peroneal tunnel [11, 12, 13]. The prominence of the retrotrochlear eminence and the thinning of the superior peroneal retinaculum (SPR) are considered to be associated with peroneal tendon tears [14]. Moreover, the presence of a peroneus quartus (PQ) muscle has the potential to create attrition or tear of the peroneal tendon at the retromalleolar groove [2, 15, 16].

Supernumerary peroneal muscles have been reported including the PQ and peroneus digiti quinti (PDQ). However, other unusual peroneal muscles are also reported [17, 18]. Therefore, the present study focused on anatomic variation of the accessory peroneal muscles and the association between these muscles and peroneal tendon tear. In addition, any possible association between these muscles and the prominence of the retrotrochlear eminence and peroneal tubercle was also investigated.

Materials and methods

This cadaveric study was approved by Institutional Review Board (IRB), Faculty of Medicine, Chulalongkorn University (IRB No. 110/61; certificate of approval No. 007/2018). We retracted legs from 109 formaldehyde-embalmed cadavers from Thai donors (55 male and 54 female) while the specimens were prone. The average age of cadaver donors at death was 77.44 ± (standard deviation, SD) 12.91 years (range from 34 to 94 years), and were obtained from the Department of Anatomy, Faculty of Medicine, Chulalongkorn University. After removing the skin, the sural nerve and small saphenous vein were distracted anteriorly. The SPR was then identified and incised to expose the superior peroneal tunnel. The presence of accessory muscles, for example, PQ and PDQ, was identified. The origin and insertion of these muscles were described. The presence of any peroneal tendon tear (Grade III or IV as described by Sobel et al.) was noted [2, 19].

Statistical analyses

Statistical analyses were conducted using IBM SPSS Statistics for Windows (version 22.0). Epidemiology of legs with each accessory peroneal muscle was descriptive statistics. The association of the peroneal tendon tear with the presence of peroneal accessory muscles, prominence of the retrotrochlear eminence, and peroneal tubercle was determined using either a χ2 test (parametric) or Kolmogorov–Smirnov sign test (nonparametric).

Results

Accessory peroneal muscles were found in 48 of 109 cases (44%). Coexistence of the PQ and an unusual accessory peroneal muscle was present in one male cadaver. We found 13 (12%) PQ, 33 (30%) PDQ, and 2 (2%) unusual peroneal muscles.

The most frequent accessory peroneal muscle was the PDQ (Figure 1). The PDQ was found bilaterally in 12 (36%) cadavers (6 male and 6 female). All of these muscles originated from the PB tendon, but their insertions were varied as summarized in Table 1. On the dorsum of the foot, almost all of the PDQ were tendinous in structure, except for one that consisted of muscle fibers (Figure 1). Most of the PQ originated from the PB muscle belly and less frequently from the PB tendon. The PQ inserted on various sites including retrotrochlear eminence, peroneal tubercle, cuboid, and dorsolateral surface of the base of the 5th metatarsal as described in Table 1 and Figure 2. The PQ was found bilaterally in 2 (15%) cases (1 male and 1 female).

Figure 1

PDQ tendon (A) and muscle (B) on the dorsal surface of foot PB tendon, peroneus brevis tendon; PDQ, peroneus digiti quinti; PL tendon, peroneus longus tendon; scale represents 2 cm

Figure 2

PQ insertion: (A) retrotrochlear eminence, (B) 5th metatarsal, (C) cuboid, (D) peroneal tubercle PB tendon, peroneus brevis tendon; PL tendon, peroneus longus tendon; PQ, peroneus quartus; SPR, superior peroneal retinaculum; scale represents 2 cm

Prevalence of accessory peroneal muscles, and their origin and insertion

Male (n = 55)Female (n = 54)Total (N = 109)
PQ8513PB muscle belly (9)Retrotrochlear eminence of calcaneus (9)
(7%)(5%)(12%)PB tendon (3)Base of 5th metatarsal (1)
PL tendon (1)Cuboid (1)
Peroneal tubercle (2)
PDQ171633PB tendon (33)Base of 5th proximal phalanx (26)
(16%)(15%)(30%)Single tendon (32)Base of 5th middle phalanx (1)
Muscle fiber (1)PDQ tendon merged with extensor digitorum longus and inserted at the base of 5th distal phalanx (4) Shaft of 5th metatarsal (2)
Unusual accessory1 (1%)1 (1%)2 (2%)PL muscle (1)Peroneal tubercle between the inferior peroneal retinaculum septum (1)
peronealPL tendon and PB muscle (1)Tendon bifurcated, one inserted at the talus and peroneal tubercle and the other at the retrotrochlear eminence (1)

PB, peroneus brevis; PDQ, peroneus digiti quinti; PL, peroneus longus; PQ, peroneus quartus

Unusual accessory peroneal muscles were observed in 2 specimens (1 male, 1 female). In one, an unusual accessory peroneus muscle originated from the PL muscle and inserted on the peroneal tubercle (Figure 3). The other had 2 heads of origin: one from the PL tendon and the other from the lower part of the PB muscle at the distal end of fibula. Both parts united and coursed over the PL tendon at the lateral malleolus before splitting into 2 tendons. One tendon inserted on the retrotrochlear eminence and the other on the talus and peroneal tubercle (Figure 4). The PQ coexisted and inserted at retrotrochlear eminence (Figure 4).

Figure 3

Unusual accessory peroneal muscle (*) (A) arose from PL muscle (B) inserted at peroneal tubercle LM, lateral malleolus; PB muscle, peroneus brevis muscle; PL, peroneus longus; scale represents 2 cm

Figure 4

Unusual accessory peroneal muscle (*) which coexisted with PQ muscle; the origin of unusual accessory peroneal muscle (arrows) from PL and PB IPR, inferior peroneal retinaculum; LM, lateral malleolus; PB tendon, peroneus brevis tendon; PL tendon, peroneus longus tendon; PQ, peroneus quartus; scale represents 2 cm

Evidence of a PB tendon tear was found in 14 of 109 cases (13%; Figure 5). However, there was no PL tendon tear in any case. The peroneal tubercle was found in 51 (47%) cases and retrotrochlear eminence was found in 87 (80%). All tendon tears were asymmetrical. No significant association was found between the presence of accessory peroneal muscles (either PQ or PDQ) and the prominence of the retrotrochlear eminence or peroneal tubercle (Tables 2 and 3). Moreover, there was no significant association between PB tendon tears and prominence of the retrotrochlear eminence or peroneal tubercle (Table 4). There was no coexistence of PQ and PB tendon tears in any case. PB tendon tears coexisted with a PDQ in 6 (43%) cases. However, there was no significant association between PB tendon tears and the presence of either a PQ or PDQ (Table 5).

Figure 5

Grade IV of PQ tendon tear (arrows) PB tendon, peroneus brevis tendon; PL tendon, peroneus longus tendon; PQ, peroneus quartus; scale represents 2 cm

Association between PQ and the prominence of a retrotrochlear eminence or peroneal tubercle

PQTotalχ2test
PresentAbsent
Prominent retrotroch-Present127587
lear eminenceAbsent12122P = 0.23
Prominent peronealPresent74451
tubercleAbsent65258P = 0.58

PQ, peroneus quartus

Association between PDQ and the prominence of a retrotrochlear eminence or peroneal tubercle

PDQ
PresentAbsentTotalχ2 test
Prominent retrotrochlearPresent276087P = 0.73
eminenceAbsent61622
Prominent peronealPresent173451P = 0.52
tubercleAbsent164258

PDQ, peroneus digiti quinti

Association between PB tendon tears and the prominence of a retrotrochlear eminence or peroneal tubercle

PB tendon tear
PresentAbsentTotalχ2 test
Prominent retrotrochlearPresent137487
eminenceAbsent12122P = 0.19
Prominent peronealPresent74451
tubercleAbsent75158P = 0.80

PB, peroneus brevis

Association between PB tendon tears and the presence of a PQ or PDQ

PB tendon tear
PresentAbsentTotalχ2test
PQPresent01313P = 0.14
Absent148296
PDQPresent62733
Absent86876P = 0.27

PB, peroneus brevis; PDQ, peroneus digiti quinti; PQ, peroneus quartus

Discussion

In the present study, we found 44% prevalence of accessory peroneal muscles in cadavers of Thai individuals. These muscles were PDQ, PQ, and unusual accessory peroneal muscles. The prevalence of PDQ was 30%, which is similar to that found previously (30%–50%) [20, 21]. The PDQ was commonly found bilaterally and predominantly in men [22]. By contrast, the prevalence of bilateral PDQ in an Indian population was only 5% [20]. The PDQ separates from the PB tendon as a slender tendon [20, 21]. In the present study, we found one PDQ with muscle fibers. Most of the PDQ inserted on the different parts of the 5th toe including shaft of metatarsal and bases of proximal, middle, and distal phalanges. Moreover, the PDQ tendon merged with that of the extensor digitorum longus and inserted at the base of distal phalanx in 3 cases. Demir et al. described the insertion pattern of the PDQ as having 2 different types: a single tendon attached to the 5th metatarsal bone and 2 separated tendons attached to different parts of the 5th metatarsal bone [21]. Moreover, dual insertion of PDQ on the 4th and 5th metatarsals was reported in 3% of PDQ cases [20]. In the present study, all PDQ had a single tendon.

The prevalence of the PQ in this study was 12% and predominantly found in male cadavers in accordance with previous studies (5%–22%) [12, 14, 22, 23, 24]. The PQ muscle arose only from the PB muscle belly and its tendon, and not from the distal shaft of the fibula or posterior intermuscular septum as previously described [22, 23, 24]. The PQ had a single tendon and inserted at various sites including retrotrochlear eminence, peroneal tubercle, base of 5th metatarsal, and cuboid. However, Bilgili et al. reported the case of a PQ with 2 separated tendons that inserted at different points. In that case, the PQ tendon was bifurcated and coursed above and beneath the PB tendon to insert at the retrotrochlear eminence and cuboid bone [23]. The PQ is reported to coexist with hypertrophy of the peroneal tubercle or retrotrochlear eminence [15, 25]. In the present study, only 7 of 51 cases with a prominent peroneal tubercle and 12 of 87 cases with a prominent retrotrochlear eminence were found to have this coexistence (Table 2). Therefore, the association between the prominence of the retrotrochlear eminence or peroneal tubercle and the presence of the PQ was not significant. Moreover, the hypertrophy of a peroneal tubercle and a prominent retrotrochlear eminence was present in an asymptomatic ankle without the presence of a PQ in accordance with previous findings [14, 26].

Tubbs et al. reported an unusual accessory muscle called the peroneotalocalcaneus muscle. This muscle originated from the anterior intermuscular septum and PL muscle and inserted on the superior surface of the talus and calcaneus [17]. Moreover, Fabrizio reported an anomalous fibularis (peroneal) muscle. This muscle arose from the muscle belly of the PL muscle in the proximal half and gave rise to a long slender tendon, which coursed posteriorly to lateral malleolus, and inserted on the superficial aspect of inferior peroneal retinaculum [18]. In the present study, unusual accessory peroneal muscles were found in 1 instance in each sex (2%). One of these muscles arose from the PL and inserted at the peroneal tubercle between the inferior peroneal retinaculum septum. The other arose from the PL tendon and PB muscle and gave rise to 2 tendons inserted at different points. One tendon inserted on the talus and peroneal tubercle, while the other inserted on the retrotrochlear eminence.

A peroneal tendon tear or attrition was reported as a consequence of acute mechanical or the repetitive injury such as trauma, mechanical irritation, or attrition within the retromalleolar groove, subluxation of the SPR, incompetent SPR, and ankle instability [4, 9, 14]. Zammit and Singh stated that there were several anatomical factors associated with peroneal tendon tears, such as the prominence of the retrotrochlear eminence and the thinning or laxity of the SPR [14]. In the present study, only 13 of 87 specimens with a prominent retrotrochlear eminence coexisted with a PB tendon tear. Therefore, no significant association was found. Previous studies had reported that the presence of a PQ has the potential to create attrition or a tear of the peroneal tendon at the retromalleolar groove [2, 15, 16]. However, none of the cases of PB tendon tear in the present study coexisted with the presence of a PQ. Moreover, the presence of a PDQ in the present study was not significantly associated with a PB tendon tear (Table 5).

Conclusions

The prevalence of PQ, PDQ, and unusual accessory peroneal muscle in Thai specimens in the present study was in agreement with previous findings in other populations. Coexistence of a PQ and an unusual accessory peroneal muscle was found in one male specimen. There was no association between PQ or PDQ and the prominence of either the retrotrochlear eminence or peroneal tubercle. Moreover, the PB tendon tears were not significantly associated with the presence of an accessory peroneal muscle or the prominence of either the retrotrochlear eminence or peroneal tubercle.

Figure 1

PDQ tendon (A) and muscle (B) on the dorsal surface of foot PB tendon, peroneus brevis tendon; PDQ, peroneus digiti quinti; PL tendon, peroneus longus tendon; scale represents 2 cm
PDQ tendon (A) and muscle (B) on the dorsal surface of foot PB tendon, peroneus brevis tendon; PDQ, peroneus digiti quinti; PL tendon, peroneus longus tendon; scale represents 2 cm

Figure 2

PQ insertion: (A) retrotrochlear eminence, (B) 5th metatarsal, (C) cuboid, (D) peroneal tubercle PB tendon, peroneus brevis tendon; PL tendon, peroneus longus tendon; PQ, peroneus quartus; SPR, superior peroneal retinaculum; scale represents 2 cm
PQ insertion: (A) retrotrochlear eminence, (B) 5th metatarsal, (C) cuboid, (D) peroneal tubercle PB tendon, peroneus brevis tendon; PL tendon, peroneus longus tendon; PQ, peroneus quartus; SPR, superior peroneal retinaculum; scale represents 2 cm

Figure 3

Unusual accessory peroneal muscle (*) (A) arose from PL muscle (B) inserted at peroneal tubercle LM, lateral malleolus; PB muscle, peroneus brevis muscle; PL, peroneus longus; scale represents 2 cm
Unusual accessory peroneal muscle (*) (A) arose from PL muscle (B) inserted at peroneal tubercle LM, lateral malleolus; PB muscle, peroneus brevis muscle; PL, peroneus longus; scale represents 2 cm

Figure 4

Unusual accessory peroneal muscle (*) which coexisted with PQ muscle; the origin of unusual accessory peroneal muscle (arrows) from PL and PB IPR, inferior peroneal retinaculum; LM, lateral malleolus; PB tendon, peroneus brevis tendon; PL tendon, peroneus longus tendon; PQ, peroneus quartus; scale represents 2 cm
Unusual accessory peroneal muscle (*) which coexisted with PQ muscle; the origin of unusual accessory peroneal muscle (arrows) from PL and PB IPR, inferior peroneal retinaculum; LM, lateral malleolus; PB tendon, peroneus brevis tendon; PL tendon, peroneus longus tendon; PQ, peroneus quartus; scale represents 2 cm

Figure 5

Grade IV of PQ tendon tear (arrows) PB tendon, peroneus brevis tendon; PL tendon, peroneus longus tendon; PQ, peroneus quartus; scale represents 2 cm
Grade IV of PQ tendon tear (arrows) PB tendon, peroneus brevis tendon; PL tendon, peroneus longus tendon; PQ, peroneus quartus; scale represents 2 cm

Association between PQ and the prominence of a retrotrochlear eminence or peroneal tubercle

PQTotalχ2test
PresentAbsent
Prominent retrotroch-Present127587
lear eminenceAbsent12122P = 0.23
Prominent peronealPresent74451
tubercleAbsent65258P = 0.58

Association between PDQ and the prominence of a retrotrochlear eminence or peroneal tubercle

PDQ
PresentAbsentTotalχ2 test
Prominent retrotrochlearPresent276087P = 0.73
eminenceAbsent61622
Prominent peronealPresent173451P = 0.52
tubercleAbsent164258

Association between PB tendon tears and the prominence of a retrotrochlear eminence or peroneal tubercle

PB tendon tear
PresentAbsentTotalχ2 test
Prominent retrotrochlearPresent137487
eminenceAbsent12122P = 0.19
Prominent peronealPresent74451
tubercleAbsent75158P = 0.80

Prevalence of accessory peroneal muscles, and their origin and insertion

Male (n = 55)Female (n = 54)Total (N = 109)
PQ8513PB muscle belly (9)Retrotrochlear eminence of calcaneus (9)
(7%)(5%)(12%)PB tendon (3)Base of 5th metatarsal (1)
PL tendon (1)Cuboid (1)
Peroneal tubercle (2)
PDQ171633PB tendon (33)Base of 5th proximal phalanx (26)
(16%)(15%)(30%)Single tendon (32)Base of 5th middle phalanx (1)
Muscle fiber (1)PDQ tendon merged with extensor digitorum longus and inserted at the base of 5th distal phalanx (4) Shaft of 5th metatarsal (2)
Unusual accessory1 (1%)1 (1%)2 (2%)PL muscle (1)Peroneal tubercle between the inferior peroneal retinaculum septum (1)
peronealPL tendon and PB muscle (1)Tendon bifurcated, one inserted at the talus and peroneal tubercle and the other at the retrotrochlear eminence (1)

Association between PB tendon tears and the presence of a PQ or PDQ

PB tendon tear
PresentAbsentTotalχ2test
PQPresent01313P = 0.14
Absent148296
PDQPresent62733
Absent86876P = 0.27

Cho J, Kim JY, Song DG, Lee WC. Comparison of outcome after retinaculum repair with and without fibular groove deepening for recurrent dislocation of the peroneal tendons. Foot Ankle Int. 2014; 35:683–9.ChoJKimJYSongDGLeeWCComparison of outcome after retinaculum repair with and without fibular groove deepening for recurrent dislocation of the peroneal tendonsFoot Ankle Int201435683910.1177/1071100714531233Search in Google Scholar

Sobel M, Bohne WH, Levy ME. Longitudinal attrition of the peroneus brevis tendon in the fibular groove: an anatomic study. Foot Ankle. 1990; 11:124–8.SobelMBohneWHLevyMELongitudinal attrition of the peroneus brevis tendon in the fibular groove: an anatomic studyFoot Ankle199011124810.1177/107110079001100302Search in Google Scholar

Sobel M, DiCarlo EF, Bohne WH, Collins L. Longitudinal splitting of the peroneus brevis tendon: an anatomic and histologic study of cadaveric material. Foot Ankle. 1991; 12:165–70.SobelMDiCarloEFBohneWHCollinsLLongitudinal splitting of the peroneus brevis tendon: an anatomic and histologic study of cadaveric materialFoot Ankle1991121657010.1177/107110079101200306Search in Google Scholar

Coughlin MJ, Schon LC. Disorders of tendon. Chapter 24. In: Coughlin MJ, Saltzman C, Anderson RB, editors. Mann’s surgery of the foot and ankle. Volume I, Part VI. Arthritis, postural disorders, and tendon disorders. 9th ed. Philadelphia: Elsevier; 2014. p. 1232–75.CoughlinMJSchonLCDisorders of tendon. Chapter 24InCoughlinMJSaltzmanCAndersonRBeditorsMann’s surgery of the foot and ankle. Volume I, Part VI. Arthritis, postural disorders, and tendon disorders. 9th edPhiladelphiaElsevier2014p123275Search in Google Scholar

Maffulli N, Ferran NA, Oliva F, Testa V. Recurrent subluxation of the peroneal tendons. Am J Sports Med. 2006; 34:986–92.MaffulliNFerranNAOlivaFTestaVRecurrent subluxation of the peroneal tendonsAm J Sports Med2006349869210.1177/0363546505283275Search in Google Scholar

Karlsson J, Wiger P. Longitudinal split of the peroneus brevis tendon and lateral ankle instability: treatment of concomitant lesions. J Athl Train. 2002; 37:463–6.KarlssonJWigerPLongitudinal split of the peroneus brevis tendon and lateral ankle instability: treatment of concomitant lesionsJ Athl Train2002374636Search in Google Scholar

Roth JA, Taylor WC, Whalen J. Peroneal tendon subluxation: the other lateral ankle injury. Br J Sports Med. 2010; 44:1047–53.RothJATaylorWCWhalenJPeroneal tendon subluxation: the other lateral ankle injuryBr J Sports Med20104410475310.1136/bjsm.2008.057182Search in Google Scholar

van Dijk PA, Gianakos AL, Kerkhoffs GM, Kennedy JG. Return to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016; 24:1155–64.van DijkPAGianakosALKerkhoffsGMKennedyJGReturn to sports and clinical outcomes in patients treated for peroneal tendon dislocation: a systematic reviewKnee Surg Sports Traumatol Arthrosc20162411556410.1007/s00167-015-3833-zSearch in Google Scholar

Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg. 2003; 42:250–8.DombekMFLammBMSaltrickKMendicinoRWCatanzaritiARPeroneal tendon tears: a retrospective reviewJ Foot Ankle Surg200342250810.1016/S1067-2516(03)00314-4Search in Google Scholar

Oliva F, Saxena A, Ferran NA, Maffulli N. Peroneal tendinopathy. In: Saxena A, editor. Sports medicine and arthroscopic surgery of the foot and ankle. Palo Alto: Springer; 2013. p. 187–212.OlivaFSaxenaAFerranNAMaffulliNPeroneal tendinopathyInSaxena A, editor. Sports medicine and arthroscopic surgery of the foot and anklePalo AltoSpringer2013p18721210.1007/978-1-4471-4106-8_15Search in Google Scholar

Lotito G, Pruvost J, Collado H, Coudreuse JM, Bensoussan L, Curvale G, et al. Peroneus quartus and functional ankle instability. Ann Phys Rehabil Med. 2011; 54:282–92. [article in English, French]LotitoGPruvostJColladoHCoudreuseJMBensoussanLCurvaleGet alPeroneus quartus and functional ankle instabilityAnn Phys Rehabil Med20115428292article in English, French10.1016/j.rehab.2011.05.00421697026Search in Google Scholar

Athavale SA, Swathi, Vangara SV. Anatomy of the superior peroneal tunnel. J Bone Joint Surg Am. 2011; 93:564–71.AthavaleSASwathiVangaraSVAnatomy of the superior peroneal tunnelJ Bone Joint Surg Am2011935647110.2106/JBJS.J.0066221411707Search in Google Scholar

Galli MM, Protzman NM, Mandelker EM, Malhotra AD, Schwartz E, Brigido SA. An examination of anatomic variants and incidental peroneal tendon pathologic features: a comprehensive MRI review of asymptomatic lateral ankles. J Foot Ankle Surg. 2015; 54:164–72.GalliMMProtzmanNMMandelkerEMMalhotraADSchwartzEBrigidoSAAn examination of anatomic variants and incidental peroneal tendon pathologic features: a comprehensive MRI review of asymptomatic lateral anklesJ Foot Ankle Surg2015541647210.1053/j.jfas.2014.11.00525619812Search in Google Scholar

Zammit J, Singh D. The peroneus quartus muscle. Anatomy and clinical relevance. J Bone Joint Surg Br. 2003; 85:1134–7.ZammitJSinghDThe peroneus quartus muscle. Anatomy and clinical relevanceJ Bone Joint Surg Br2003851134710.1302/0301-620X.85B8.1353214653594Search in Google Scholar

Sobel M, Levy ME, Bohne WH. Congenital variations of the peroneus quartus muscle: an anatomic study. Foot Ankle. 1990; 11:81–9.SobelMLevyMEBohneWHCongenital variations of the peroneus quartus muscle: an anatomic studyFoot Ankle19901181910.1177/1071100790011002042265813Search in Google Scholar

Unlu MC, Bilgili M, Akgun I, Kaynak G, Ogut T, Uzun I. Abnormal proximal musculotendinous junction of the peroneus brevis muscle as a cause of peroneus brevis tendon tears: a cadaveric study. J Foot Ankle Surg. 2010; 49:537–40.UnluMCBilgiliMAkgunIKaynakGOgutTUzunIAbnormal proximal musculotendinous junction of the peroneus brevis muscle as a cause of peroneus brevis tendon tears: a cadaveric studyJ Foot Ankle Surg2010495374010.1053/j.jfas.2010.09.00121035039Search in Google Scholar

Tubbs RS, May WR, Shoja MM, Loukas M, Salter EG, Oakes WJ. Peroneotalocalcaneus muscle. Anat Sci Int. 2008; 83:280–2.TubbsRSMayWRShojaMMLoukasMSalterEGOakesWJPeroneotalocalcaneus muscleAnat Sci Int200883280210.1111/j.1447-073X.2007.00203.x19159359Search in Google Scholar

Fabrizio PA. Unusual fibularis (peroneus) muscle. Surg Radiol Anat. 2015; 37:997–9.FabrizioPAUnusual fibularis (peroneus) muscleSurg Radiol Anat201537997910.1007/s00276-014-1400-925431295Search in Google Scholar

Davis WH, Sobel M, Deland J, Bohne WH, Patel MB. The superior peroneal retinaculum: an anatomic study. Foot Ankle Int. 1994; 15:271–5.DavisWHSobelMDelandJBohneWHPatelMBThe superior peroneal retinaculum: an anatomic studyFoot Ankle Int199415271510.1177/1071100794015005077951966Search in Google Scholar

Jadhav SD, Gosavi SN, Zambare BR. Study of peroneus digiti minimi quinti in Indian population: a cadaveric study. Rev Arg Anat Clin. 2013; 5:67–72.JadhavSDGosaviSNZambareBRStudy of peroneus digiti minimi quinti in Indian population: a cadaveric studyRev Arg Anat Clin20135677210.31051/1852.8023.v5.n2.14060Search in Google Scholar

Demir BT, Gümüşalan Y, Üzel M, Cevik HB. The variations of peroneus digiti quinti muscle and its contribution to the extension of the fifth toe. A cadaveric study. Saudi Med J. 2015; 36:1285–9.DemirBTGümüşalanYÜzelMCevikHBThe variations of peroneus digiti quinti muscle and its contribution to the extension of the fifth toe. A cadaveric studySaudi Med J2015361285910.15537/smj.2015.11.12657467336426593160Search in Google Scholar

Yammine K. The accessory peroneal (fibular) muscles: peroneus quartus and peroneus digiti quinti. A systematic review and meta-analysis. Surg Radiol Anat. 2015; 37:617–27.YammineKThe accessory peroneal (fibular) muscles: peroneus quartus and peroneus digiti quinti. A systematic review and meta-analysisSurg Radiol Anat2015376172710.1007/s00276-015-1438-325638531Search in Google Scholar

Bilgili MG, Kaynak G, Botanlioglu H, Basaran SH, Ercin E, Baca E, et al. Peroneus quartus: prevalence and clinical importance. Arch Orthop Trauma Surg. 2014; 134:481–7.BilgiliMGKaynakGBotanliogluHBasaranSHErcinEBacaEet alPeroneus quartus: prevalence and clinical importanceArch Orthop Trauma Surg2014134481710.1007/s00402-014-1937-424525795Search in Google Scholar

Athavale SA, Gupta V, Kotgirwar S, Singh V. The peroneus quartus muscle: clinical correlation with evolutionary importance. Anat Sci Int. 2012; 87:106–10.AthavaleSAGuptaVKotgirwarSSinghVThe peroneus quartus muscle: clinical correlation with evolutionary importanceAnat Sci Int2012871061010.1007/s12565-011-0129-322252433Search in Google Scholar

Wang XT, Rosenberg ZS, Mechlin MB, Schweitzer ME. Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics. 2005; 25:587–602.WangXTRosenbergZSMechlinMBSchweitzerMENormal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging featuresRadiographics20052558760210.1148/rg.25304512315888611Search in Google Scholar

Saupe N, Mengiardi B, Pfirrmann CW, Vienne P, Seifert B, Zanetti M. Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles. Radiology. 2007; 242:509–17.SaupeNMengiardiBPfirrmannCWViennePSeifertBZanettiMAnatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic anklesRadiology20072425091710.1148/radiol.242205199317255421Search in Google Scholar

Recommended articles from Trend MD

Plan your remote conference with Sciendo