Accessory Flexor Digitorum Longus Presenting as Tarsal Tunnel Syndrome

2011 ◽  
Vol 4 (6) ◽  
pp. 379-382 ◽  
Author(s):  
William E. Saar ◽  
Jennifer Bell
Keyword(s):  
Treatment Options ◽  
Flexor Hallucis Longus ◽  
Tarsal Tunnel ◽  
Foot And Ankle ◽  
Tarsal Tunnel Syndrome ◽  
Therapeutic Level ◽  
Ankle Pain ◽  
Level Of Evidence ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

The flexor digitorum accessory longus (FDAL) muscle is one of the most commonly encountered anomalous muscles in the foot and ankle. Literature has documented the prevalence of the FDAL anywhere from 4% to 12%, based on cadaveric limb dissection. The variability of the origin, insertion, size, and location of the FDAL muscle can cause a wide array of foot and ankle pathologies, most notably, tarsal tunnel syndrome and flexor hallucis longus syndrome. Accessory musculature should be included in the list of differential diagnoses for foot and ankle pain until proven otherwise. This report presents a patient who exhibited pain localized to the medial malleolar region and was initially diagnosed with likely tarsal tunnel syndrome. On magnetic resonance imaging, a FDAL muscle was identified and shown to be impinging on the posterior medial anatomic structures. The patient underwent excision of the FDAL and is symptom free to date. The discussion of this case report can prompt foot and ankle surgeons to be more aware of this infrequent finding as well as treatment options. Level of Evidence: Therapeutic, Level IV

Anatomical Characteristics of the Flexor Digitorum Accessorius Longus Muscle and Their Relevance to Tarsal Tunnel Syndrome

2015 ◽  
Vol 105 (4) ◽  
pp. 344-355 ◽  
Author(s):  
Paul-André Deleu ◽  
Bernhard Devos Bevernage ◽  
Ivan Birch ◽  
Pierre Maldague ◽  
Vincent Gombault ◽  
...  
Keyword(s):  
Systematic Review ◽  
Differential Diagnosis ◽  
Cochrane Library ◽  
Flexor Hallucis Longus ◽  
Anatomical Location ◽  
Tarsal Tunnel ◽  
Tarsal Tunnel Syndrome ◽  
Flexor Digitorum Accessorius Longus ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

Background Clinical and cadaver studies have reported that supernumerary muscles could be the etiology of a variety of pathologic disorders, such as posterior impingement syndrome, tarsal tunnel syndrome (TTS), and flexor hallucis longus tenosynovitis. We describe a unique variant of the flexor digitorum accessorius longus (FDAL) muscle as an apparent cause of TTS, functioning as an independent flexor of the second toe, which has not been described in the literature. In addition to this case report, a systematic review was performed of TTS caused by the FDAL muscle. Methods A targeted search of PubMed, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and Web of Science identified full-text papers that fulfilled the inclusion and exclusion criteria. Results Twenty-nine papers were identified for inclusion in the systematic review: 12 clinical papers of TTS caused by the FDAL muscle and 17 cadaver-based papers. Conclusions Clinicians often do not include the FDAL muscle in the differential diagnosis of TTS. This literature review suggests that the FDAL is an important muscle in terms of its functional and clinical significance. Knowledge of this muscle, its anatomical location and variations, and its magnetic resonance imaging characteristics may help clinicians make an accurate differential diagnosis.

Nonunion of a Fracture of the Sustentaculum Tali Causing a Tarsal Tunnel Syndrome: A Case Report

1995 ◽  
Vol 16 (11) ◽  
pp. 740-742 ◽  
Author(s):  
Mark S. Myerson ◽  
Barry I. Berger
Keyword(s):  
Case Report ◽  
Tibial Nerve ◽  
Fibrous Tissue ◽  
Tarsal Tunnel ◽  
Foot And Ankle ◽  
Tarsal Tunnel Syndrome ◽  
Ankle Pain ◽  
History Of ◽  
Tunnel Syndrome ◽  
Bony Mass

A middle-aged man sustained an isolated sustentaculum tali fracture that formed a stable nonunion. Subsequently, tarsal tunnel syndrome developed when this sustentacular fragment migrated superiorly to cause tibial nerve impingement. The patient presented with a history of longstanding foot and ankle pain. He was pain-free 2 weeks after excision of the bony mass encased in fibrous tissue.

Tarsal Tunnel Syndrome Associated with an Accessory Muscle

2003 ◽  
Vol 24 (2) ◽  
pp. 132-136 ◽  
Author(s):  
Mitsuo Kinoshita ◽  
Ryuzo Okuda ◽  
Junichi Morikawa ◽  
Muneaki Abe
Keyword(s):  
Signs And Symptoms ◽  
Tarsal Tunnel ◽  
Tarsal Tunnel Syndrome ◽  
Accessory Muscle ◽  
History Of ◽  
Tunnel Syndrome ◽  
The Mean ◽  
Electrophysiological Examination ◽  
Flexor Digitorum ◽  
Physical Findings

Between 1986 and 1999, we surgically treated 41 patients (49 feet) with Tarsal Tunnel Syndrome (TTS) in whom seven (eight feet) were associated with an accessory muscle. An accessory flexor digitorum longus muscle was present in six patients, and an accessory soleus muscle was in one patient (both feet). Three of them were males and four females, with the mean age of 33.1 years (12 to 59 years). The mean interval from the onset of symptoms to operation was 7.5 months (range, six to nine months). All patients with an accessory muscle had a history of trauma or strenuous sporting activity. The diagnosis of TTS was made based on physical findings in all the patients (eight feet) and confirmed in five patients (six feet) by electrophysiological examination. Imaging examinations (radiography, ultrasonography, MRI) revealed abnormal bone and soft tissue lesions in and around the tarsal tunnel. Preoperative signs and symptoms disappeared average 4.1 months after decompression of the tibial nerve in addition to excision of the muscle. No functional deficit was observed at final follow-up (24 to 88 months).

scholarly journals An Erratic Origin of Quadratus Plantae: An Embryological Error

2021 ◽  
Vol 9 (4) ◽  
pp. 8168-8172
Author(s):  
Sobana Mariappan ◽  
◽  
Geeta Anasuya. D ◽  
Sheela Grace Jeevamani MS ◽  
M. Vijaianand MD ◽  
...  
Keyword(s):  
Tarsal Tunnel ◽  
Main Function ◽  
Resonance Imaging ◽  
Tarsal Tunnel Syndrome ◽  
Flexor Digitorum Longus ◽  
Accessory Muscle ◽  
Male Cadaver ◽  
Flexor Digitorum Accessorius Longus ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

Background: Quadratus plantae (Flexor digitorum accessorius) is one of the plantar muscles of foot . It is present in the second layer of sole. It takes origin from calcaneus and gets inserted into the tendon of flexor digitorum longus. The main function of it is to flex the lateral four toes in any position of the ankle joint by pulling on tendons of the flexor digitorum longus. Its variations like high origin have been implicated in the causation of tarsal tunnel syndrome. Methodology and Results: In routine dissection done on 22 cadavers, we observed a bilateral variant muscle flexor digitorum accessorius longus on both right and left sides in a male cadaver. The modality of choice in diagnosing the accessory muscle is magnetic resonance imaging. Conclusion: The knowledge of this variation would be essential to anatomists, radiologists and also to the foot surgeons while performing posterior ankle endoscopy. KEY WORDS: Flexor digitorum Accessorius longus, Tarsal tunnel syndrome, Posterior ankle endoscopy.

Nerve Injuries in the Foot and Ankle: Neuromas, Neuropathy, Entrapments, and Tarsal Tunnel Syndrome

2021 ◽  
pp. 295-300
Author(s):  
Lorraine Boakye ◽  
Nia A. James ◽  
Cortez L. Brown ◽  
Stephen P. Canton ◽  
Devon M. Scott ◽  
...  
Keyword(s):  
Tarsal Tunnel ◽  
Foot And Ankle ◽  
Tarsal Tunnel Syndrome ◽  
Nerve Injuries ◽  
Tunnel Syndrome

scholarly journals Endoscopic Adhesiolysis of the Flexor Hallucis Longus Muscle

2014 ◽  
Vol 7 (6) ◽  
pp. 492-494 ◽  
Author(s):  
T.H. Lui
Keyword(s):  
Tibial Fracture ◽  
Distal Tibia ◽  
Hallux Rigidus ◽  
Flexor Hallucis Longus ◽  
Therapeutic Level ◽  
Ankle Pain ◽  
Level Of Evidence ◽  
Soft Tissue Dissection ◽  
Longus Muscle ◽  
Hallux Flexus

Flexor hallucis longus muscle can adhere to the distal tibia after tibial fracture. The patient may complain of deep posteromedial ankle pain, checkrein deformity of the hallux, hallux flexus or development of hallux rigidus. Surgical treatment of release of the FHL muscle or lengthening of the FHL tendon has been proposed. We described an endoscopic approach of release of the FHL muscle from the distal tibia with the advantage of minimal soft tissue dissection. Level of Evidence: Therapeutic Level V: Expert Opinion/Technique

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