Skip to main content
SpringerLink
Log in

Congenital Variations of the Peroneal Tendons

  • Chapter
  • First Online:
The Peroneal Tendons

  • 553 Accesses

Abstract

Stenosing tenosynovitis, subluxation of the peroneal tendons, and peroneus brevis split tears can occur in association with an encroachment of an anomalous peroneus quartus tendon or low-lying peroneus brevis muscle belly. The presence of extra tissue within the fibular groove can contribute to stenosis or subluxation of the peroneus brevis tendon causing laxity of the superior peroneal retinaculum and eventually subluxation or dislocation of the peroneus brevis over the sharp posterior ridge of the distal fibula. This dynamic mechanism can eventually result in splitting or tearing of the peroneus brevis tendon. A convex or shallow fibular groove can further contribute to this dynamic phenomenon in Zone A. Also, an irregular retromalleolar groove predisposes to peroneal tendon disease. Hypertrophy of the peroneal tubercle along the lateral wall of the calcaneus can also contribute to stenosing tenosynovitis and impingement of the peroneal tendons in Zone B. The presence of an enlarged os peroneum can contribute to stenosing tenosynovitis or rupture of the peroneus longus tendon in the cuboid tunnel Zone C. Fracture of an enlarged or bipartite os peroneum with proximal migration of the proximal pole of the os peroneum can lead to peroneus longus tendon rupture.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Bibliography

  1. Hecker P. Study on the peroneus of the tarsus. Anat Rec. 1923;26:79–82.

    Google Scholar 

  2. Sobel M, Levy ME, Bohne WHO. Congenital variations of the peroneus quartus muscle: an anatomic study. Foot Ankle. 1990;11:81–9.

    CAS  PubMed  Google Scholar 

  3. Sobel M, Geppert MJ, Olson EJ, Bohne WHO, Arnoczky SP. The dynamics of peroneus brevis tendon splits: a proposed mechanism, technique of diagnosis, and classification of injury. Foot Ankle. 1992;13:413–22.

    CAS  PubMed  Google Scholar 

  4. Donley BG, Leyes M. Peroneus quartus muscle. Am J Sports Med. 2001;29:373–5.

    CAS  PubMed  Google Scholar 

  5. Zammit J, Singh D. The peroneus quartus muscle. Anatomy and clinical relevance. J Bone Joint Surg Br. 2003;85-B:1134–7.

    Google Scholar 

  6. Bilgili MG, Kaynak G, Botanlıoğlu H, Basaran SH, Ercin E, Baca E, Uzun I. Peroneus quartus: prevalence and clinical importance. Arch Orthop Trauma Surg. 2014;134:481–7.

    PubMed  Google Scholar 

  7. Yammine K. The accessory peroneal (fibular) muscles: peroneus quartus and peroneus digitiquinti. A systematic review and meta-analysis. Surg Radiol Anat. 2015;37:617–27.

    PubMed  Google Scholar 

  8. Athavale SA, Vangara SV. Anatomy of the superior peroneal tunnel. J Bone Joint Surg. 2011;93(6):564–71.

    PubMed  Google Scholar 

  9. Athavale SA, Gupta V, Kotgirwar S, Singh V. The peroneus quartus muscle: clinical correlation with evolutionary importance. Anat Sci Int. 2012;87:106–10.

    PubMed  Google Scholar 

  10. Habashy A, Cook B, Sumarriva G, Treuting R. Peroneus quartus muscle. Am J Orthop. 2017;46:E419–22.

    PubMed  Google Scholar 

  11. Chinzei N, Kanzaki N, Takakura Y, Takakura Y, Toda A, Fujishiro T, Hayashi S, Hashimoto S, Kuroda R, Kurosaka M. Surgical management of the peroneus quartus muscle for bilateral ankle pain. J Am Podiatr Med Assoc. 2015;105:85–91.

    PubMed  Google Scholar 

  12. Sönmez M, Kosar ÇM. The supernumerary peroneal muscles: case report and review of the literature. Foot Ankle Surg. 2000;6:125–9.

    Google Scholar 

  13. Moroney P, Borton D. Multiple accessory peroneal muscles: a cause of chronic lateral ankle pain. Foot Ankle Int. 2004;25:322–4.

    PubMed  Google Scholar 

  14. Prakash NC, Singh DK, Rajini T, Venkatiah J, Singh G. Anatomical variations of peroneal muscles. J Am Podiatr Med Assoc. 2011;101:505–8.

    CAS  PubMed  Google Scholar 

  15. Saupe N, Mengiardi B, Pfirrmann CWA, 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.

    PubMed  Google Scholar 

  16. Chepuri NB, Jacobson JA, Fessell DP, Hayes CW. Sonographic appearance of the peroneus quartus muscle: correlation with MR imaging appearance in seven patients. Radiology. 2001;218:415–9.

    CAS  PubMed  Google Scholar 

  17. Cheung YY, Rosenberg ZS, Ramsinghani R, Beltran J, Jahss MH. Peroneus quartus muscle: MR imaging features. Radiology. 1997;202:745–50.

    CAS  PubMed  Google Scholar 

  18. Sammarco GJ, Brainard BJ. A symptomatic anomalous peroneus brevis in a high-jumper. A case report. J Bone Joint Surg Am. 1991;73:131–3.

    CAS  PubMed  Google Scholar 

  19. Martinelli B, Bernobi S. Peroneus quartus muscle and ankle pain. Foot Ankle Surg. 2002;8:223–5.

    Google Scholar 

  20. Nascimento SRR, Costa RW, Ruiz CR, Wafae N. Analysis on the incidence of the fibularis quartus muscle using magnetic resonance imaging. Anat Res Int. 2012;2012:1–6.

    Google Scholar 

  21. Kulshreshtha R, Kadri S, Rajan DT. A case of unusual combination of injuries around the lateral malleolus. Foot. 2006;16:51–3.

    Google Scholar 

  22. Davis WH, Sobel M, Deland J, Bohne WH, Patel MB. The superior peroneal retinaculum: an anatomic study. Foot Ankle Int. 1994;15:271–5.

    CAS  PubMed  Google Scholar 

  23. Geppert MJ, Sobel M, Bohne WH. Lateral ankle instability as a cause of superior peroneal retinacular laxity: an anatomic and biomechanical study of cadaveric feet. Foot Ankle. 1993;14:330–4.

    CAS  PubMed  Google Scholar 

  24. Gumusalan Y, Ozbag D. A variation of fibularis quartus muscles: musculus fibulocalcaneusexternum. Clin Anat. 2007;20:998–9.

    PubMed  Google Scholar 

  25. Regan TP, Hughston JC. Chronic ankle “sprain” secondary to anomalous peroneal tendon. Clin Orthop Relat Res. 1977;123:52–4. https://doi.org/10.1097/00003086-197703000-00020.

    Article  Google Scholar 

  26. Mick CA, Lynch F. Reconstruction of the peroneal retinaculum using the peroneus quartus. A case report. J Bone Joint Surg. 1987;69:296–7.

    CAS  PubMed  Google Scholar 

  27. White AA, Johnson D, Griswold DM. Chronic ankle pain associated with the peroneus accessorius. Clin Orthop Relat Res. 1974;103:53–5.

    Google Scholar 

  28. Taljanovic MS, Alcala JN, Gimber LH, Rieke JD, Chilvers MM, Latt LD. High-resolution US and MR imaging of peroneal tendon injuries. Radiographics. 2015;35(1):179–99.

    PubMed  Google Scholar 

  29. Öznur A, Arik A, Alanay A. Peroneus quartus muscle as a rare cause of the chronic lateral ankle pain. Foot Ankle Surg. 2002;8(3):227–30.

    Google Scholar 

  30. Sobel M, Mizel MS. Peroneal tendon injury. In: Pfeffer GB, Frey CC, editors. Current practice in foot and ankle surgery. New York: McGraw-Hill, Health Professions Division; 1993. p. 33.

    Google Scholar 

  31. Sobel M, Bohne WHO, Obrien SJ. Peroneal tendon subluxation in a case of anomalous peroneus brevis muscle. Acta Orthop Scand. 1992;63:682–4.

    CAS  PubMed  Google Scholar 

  32. Sobel M, Mizel MS. Peroneal tendon injury. In: Pfeffer GB, Frey CC, editors. Current practice in foot and ankle surgery. New York: McGraw-Hill, Health Professions Division; 1993. p. 34.

    Google Scholar 

  33. Sobel M, Mizel MS. Peroneal tendon injury. In: Pfeffer GB, Frey CC, editors. Current practice in foot and ankle surgery. New York: McGraw-Hill, Health Professions Division; 1993. p. 35.

    Google Scholar 

  34. Amini B. Low-lying peroneus brevis muscle belly [Internet Blog]. Roentgen ray reader 2011. Accessed 5 Nov 2018. Available from: http://roentgenrayreader.blogspot.com/2011/11/low-lying-peroneus-brevis-muscle-belly.html.

  35. Dombek MF, Lamm BM, Saltrick K, Mendicino RW, Catanzariti AR. Peroneal tendon tears: a retrospective review. J Foot Ankle Surg. 2003;42:250–8.

    PubMed  Google Scholar 

  36. Geller J, Lin S, Cordas D, Vieira P. Relationship of a low-lying muscle belly to tears of the peroneus brevis tendon. Am J Orthop (Belle Mead NJ). 2003;32:541–4.

    Google Scholar 

  37. Mirmiran R, Squire C, Wassell D. The prevalence and role of a low-lying peroneus brevis muscle belly in patients with peroneal tendon pathologic features: a potential source of tendon subluxation. J Foot Ankle Surg. 2015;54:872–5.

    PubMed  PubMed Central  Google Scholar 

  38. Highlander P, Pearson KT, Burns P. Magnetic resonance imaging analysis of peroneal tendon pathology associated with low-lying peroneus brevis muscle belly. Foot Ankle Spec. 2015;8:347–53.

    PubMed  Google Scholar 

  39. Freccero DM, Berkowitz MJ. The relationship between tears of the peroneus brevis tendon and the distal extent of its muscle belly: an MRI study. Foot Ankle Int. 2006;27:236–9.

    PubMed  Google Scholar 

  40. 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.

    PubMed  Google Scholar 

  41. Housley SN, Lewis JE, Thompson DL, Warren G. A proximal fibularis brevis muscle is associated with longitudinal split tendons: a cadaveric study. J Foot Ankle Surg. 2017;56:34–6.

    PubMed  Google Scholar 

  42. Hammerschlag WA, Goldner JL. Chronic peroneal tendon subluxation produced by an anomalous peroneus brevis: case report and literature review. Foot Ankle. 1989;10:45–7.

    CAS  PubMed  Google Scholar 

  43. Sobel M, Mizel MS. Peroneal tendon injury. In: Pfeffer GB, Frey CC, editors. Current practice in foot and ankle surgery. New York: McGraw-Hill, Health Professions Division; 1993. p. 32.

    Google Scholar 

  44. Sobel M, Mizel MS. Peroneal tendon injury. In: Pfeffer GB, Frey CC, editors. Current practice in foot and ankle surgery. New York: McGraw-Hill, Health Professions Division; 1993. p. 30–3.

    Google Scholar 

  45. Rosenberg ZS, Bencardino J, Astion D, Schweitzer ME, Rokito A, Sheskier S. MRI features of chronic injuries of the superior peroneal retinaculum. Am J Roentgenol. 2003;181:1551–7.

    Google Scholar 

  46. Wang X-T, 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.

    PubMed  Google Scholar 

  47. Edwards ME. The relations of the peroneal tendons to the fibula, calcaneus, and cuboideum. Am J Anat. 1928;42:213–53.

    Google Scholar 

  48. Kumai T, Benjamin M. The histological structure of the malleolar groove of the fibula in man: its direct bearing on the displacement of peroneal tendons and their surgical repair. J Anat. 2003;203:257–62.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Sobel M, Pavlov H, Geppert MJ, Thompson FM, Dicarlo EF, Davis WH. Painful Os peroneum syndrome: a spectrum of conditions responsible for plantar lateral foot pain. Foot Ankle Int. 1994;15:112–24.

    CAS  PubMed  Google Scholar 

  50. Davda K, Malhotra K, O’Donnell P, Singh D, Cullen N. Peroneal tendon disorders. EFORT Open Rev. 2017;2:281–92.

    PubMed  PubMed Central  Google Scholar 

  51. Sugimoto K, Takakura Y, Okahashi K, Tanaka Y, Ohshima M, Kasanami R. Enlarged peroneal tubercle with peroneus longus tenosynovitis. J Orthop Sci. 2009;14:330–5.

    PubMed  Google Scholar 

  52. Hyer CF, Dawson JM, Philbin TM, Berlet GC, Lee TH. The peroneal tubercle: description, classification, and relevance to peroneus longus tendon pathology. Foot Ankle Int. 2005;26:947–50.

    PubMed  Google Scholar 

  53. Hofmeister E, Juliano P, Lippert F. The anatomical configuration and clinical implications of the peroneal tubercle. Foot. 1996;6:138–42.

    Google Scholar 

  54. Palmanovich E, Laver L, Brin YS, Kotz E, Hetsroni I, Mann G, Nyska M. Peroneus longus tear and its relation to the peroneal tubercle: a review of the literature. Muscles Ligaments Tendons J. 2011;4:153–60.

    Google Scholar 

  55. Dr-P A Peroneal Tendon Complex Injury And Rehabilitation. In: 986 Dr Pributs Blog. https://www.drpribut.com/wordpress/2017/10/peroneal-tendon-complex-injury-and-rehabilitation/. Accessed 24 Oct 2018.

  56. Pierson JL, Inglis AE. Stenosing tenosynovitis of the peroneus longus tendon associated with hypertrophy of the peroneal tubercle and an os peroneum. A case report. J Bone Joint Surg Am. 1992;74:440–2.

    CAS  PubMed  Google Scholar 

  57. Bruce WD, Christofersen MR, Phillips DL. Stenosing tenosynovitis and impingement of the peroneal tendons associated with hypertrophy of the peroneal tubercle. Foot Ankle Int. 1999;20:464–7.

    CAS  PubMed  Google Scholar 

  58. Lui TH. Endoscopic resection of the peroneal tubercle. J Foot Ankle Surg. 2012;51:813–5.

    PubMed  Google Scholar 

  59. Chen YJ, Hsu RW, Huang TJ. Hypertrophic peroneal tubercle with stenosing tenosynovitis: the results of surgical treatment. Changgeng Yi Xue Za Zhi. 1998;21:442–6.

    CAS  PubMed  Google Scholar 

  60. Burman M. Stenosing tendovaginitis of the foot and ankle: studies with special reference to the stenosing tendovaginitis of the peroneal tendons at the peroneal tubercle. AMA Arch Surg. 1953;67:686.

    CAS  PubMed  Google Scholar 

  61. Brandes CB, Smith RW. Characterization of patients with primary peroneus longus tendinopathy: a review of twenty-two cases. Foot Ankle Int. 2000;21:462–8.

    CAS  PubMed  Google Scholar 

  62. Dutton P, Edmonds EW, Lark RK, Mubarak SJ. Prevalence of painful peroneal tubercles in the pediatric population. J Foot Ankle Surg. 2012;51:599–603.

    PubMed  Google Scholar 

  63. Taki K, Yamazaki S, Majima T, Ohura H, Minami A. Bilateral stenosing tenosynovitis of the peroneus longus tendon associated with hypertrophied peroneal tubercle in a junior soccer player: a case report. Foot Ankle Int. 2007;28:129–32.

    PubMed  Google Scholar 

  64. Watson GI, Karnovsky SC, Levine DS, Drakos MC. Surgical treatment for stenosing peroneal tenosynovitis. Foot Ankle Int. 2018;40:282–6.

    PubMed  Google Scholar 

  65. Sarrafian SK. Anatomy of the foot and ankle: descriptive, topographic, functional. Philadelphia: J.B. Lippincott; 2011.

    Google Scholar 

  66. Mook WR, Parekh SG, Nunley JA. Allograft reconstruction of peroneal tendons. Foot Ankle Int. 2013;34:1212–20.

    PubMed  Google Scholar 

  67. Wapner KL, Taras JS, Lin SS, Chao W. Staged reconstruction for chronic rupture of both peroneal tendons using hunter rod and flexor hallucis longus tendon transfer: a long-term follow up study. Foot Ankle Int. 2006;27:591–7.

    PubMed  Google Scholar 

  68. Jockel JR, Brodsky KW. Single-stage flexor tendon transfer for the treatment of severe concomitant peroneus longus and brevis tendon tears. Foot Ankle Int. 2013;34:666–72.

    PubMed  Google Scholar 

  69. Seybold JD, Campbell JT, Jeng CL, Short KW, Myerson MS. Outcome of lateral transfer of the FHL or FDL for concomitant peroneal tendon tears. Foot Ankle Int. 2016;37:576–81.

    PubMed  Google Scholar 

  70. Barton DC, Lucas P, Jomha NM, Cross MJ, Slater K. Operative reconstruction after transverse rupture of the tendons of both peroneus longus and brevis: surgical reconstruction by transfer of the flexor digitorum longus tendon. J Bone Joint Surg Br. 1998;80:781–4.

    Google Scholar 

  71. Blitz NM, Nemes KK. Bilateral peroneus longus tendon rupture through a bipartite os peroneum. J Foot Ankle Surg. 2007;46(4):270–7.

    PubMed  Google Scholar 

  72. Stockton KG, Brodsky JW. Peroneus longus tears associated with pathology of the os peroneum. Foot Ankle Int. 2014;35:346–52.

    PubMed  Google Scholar 

  73. Smith JT, Johnson AH, Heckman JD. Nonoperative treatment of an osperoneum fracture in a high-level athlete: a case report. Clin Orthop Relat Res. 2011;469:1498–501.

    PubMed  PubMed Central  Google Scholar 

  74. Hamilton P, Robinson AHN. Peroneal tendon disorders. In: Bentley G. (eds) Eur Surg Orthop Traumatol. Springer, Berlin, Heidelberg. 2014:3637–57.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Icahn School of Medicine at Mount Sinai, Biomedical Sciences, New York, NY, USA

    Jay M. Sobel

  2. Lenox Hill Hospital – Northwell Health, Orthopaedic Surgery, New York, NY, USA

    Mark Sobel

Authors
  1. Jay M. Sobel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Sobel
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Private Practice, Atlantic Highlands, NJ, USA

    Mark Sobel

Electronic Supplementary Material

The Dynamics of Peroneus Brevis Splits/Tears

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sobel, J.M., Sobel, M. (2020). Congenital Variations of the Peroneal Tendons. In: Sobel, M. (eds) The Peroneal Tendons. Springer, Cham. https://doi.org/10.1007/978-3-030-46646-6_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-46646-6_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-46645-9

  • Online ISBN: 978-3-030-46646-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation