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ORIGINAL ARTICLE

Variation In Peroneus Teritius Tendon And Its Clinical Implications

Chintan Rohitkumar Bhatt, Meenakshi Sanjay Modi, Chandrakant D Mehta

Govt Medical College, Surat.


Address for Correspondence:

Chintan Rohitkumar Bhatt
Tutor in Anatomy
Govt Medical College, Surat,India.
E-Mail: drchintanbhatt@yahoo.co.in

Abstract:

Peroneus tertius (PT) is a muscle of the anterior compartment of the leg. The PT muscle originates from the anterior surface of the fibula and the interosseous membrane and inserts into the medial side of the dorsal region of the fifth metatarsal bone. We have dissected 94 cadavers to see the variation in the Peroneus tertius muscle, we found some or the other variation in 8 cases, and absence of muscle in 10 cases. In the variation the common variation is that the PT tendon arises from the tendon the fourth digitations of the extensor digitorium longus or just an extension of it. Usually, the PT is involved in dorsiflexion and eversion of the foot. In many cases, the absence of PT maybe asymptomatic and it may be incidentally detected during cadaveric dissections or autopsies. The existence of PT may help in the swing phase of bipedal walking. The PT may be used for tendon graft surgeries. The pull of the PT may be responsible for causing stress on the fifth metacarpal and account for all stress fractures in any individual. The absence of the PT may puzzle any transplant and foot surgeons performing graft operations. We as anatomists discuss the clinical implications of the variations of PT.

J.Orthopaedics 2010;7(2)e1

Keywords:

Peroneus tertius muscle; variation; dissection.

Introduction:

Peroneus tertius (PT) is a muscle of the anterior compartment of the leg. The PT muscle originates from the anterior surface of the fibula and the interosseous membrane and inserts into the medial side of the dorsal region of the fifth metatarsal bone. With the adaptation to erect posture the foot had not only to bear weight but also to maintain the balance of body while walking and standing on uneven surfaces. The Peroneus are the cornerstone muscles that have evolved to perform this function muscles Variations of these are more frequent than supposed and their distal attachments are not absolutely at a fixed position. The Peroneus muscles may show variations as a whole or share in a certain measure the general prerogatives of the muscular system. These muscles attract attention on account of their pronounced relation to the plantar or tarsian arches. They are major everters and are involved in complex actions such as dancing and skating. The importance of the role of Peroneus in the pathogenesis of pes cavovarus may be more crucial than has been reported.

Materials and Methods:

We have observed 94 cadaveric lower limbs which are given to the undergraduate students to dissect in the government medical college, Surat and from the municipal medical college, Surat for last 3 years. The dissection was done by the students under guidance of the teachers and according to the Cunningham manual of dissection of anatomy.

The Peroneus tertius muscle is the muscle of anterior compartment of the leg. We have studied 94 cases for the variation in the Peroneus muscle. We have found that in 10 cases Peroneus tertius muscle is absent. As we can see in the fig.1 that the Peroneus tertius muscle is absent in this case.

The other common variation of the Peroneus tertius muscle that slips arises from the 4th tendon of extensor digitorium longus. This slip strengthens the muscle and helps in the action of PT. In other case as we can seen in the fig that one extra slip of fibers are going from the extensor digitorium longus to the Peroneus tertius. Such types of 6 cases have been found. (Fig.2).

As we can see in fig.3 in 2 cases we found that the Peroneus tertius muscle and the fourth digitations of the extensor digitorium longus has a single belly where as their insertion is at their normal anatomical site.

Discussion :

The peroneus tertius is absent in 5% to 17% of the human white population. The function of the peroneus tertius is eversion and dorsiflexion of the foot. These 2 strength parameters have been identified as important parameters in the development of ankle ligament injuries.1 The study by Das SS shows that absent of Peroneus tertius muscle is around 10.5% of Cases.2 We found 10 cases of absence Peroneus tertius muscle. This figure is almost similar with other authers such as Wood (9.8%),Le Double (9.1%), J Bertelli & Z Khoury(9.1%).3 Peroneus tertius muscle is helpful in the swing phase of the bipedal mode of locomotion. The tendon of Peroneus tertius muscle also helpful in the transplant surgeries. We also found the 6 cases where the Peroneus tertius muscle is just the extra digitations or slips of fibers arises from the 4th tendon of the extensor digitorium longus muscle. The maximum length of the slip is 7.2 cm and the mean length is 6.4cm.  The insertion of the both muscle is at the usual site. The slip generally arises after the tendon crosses the ankle joint. It shows that the muscle has limited role in dorsiflexion at the ankle joint. The clinical importance of the Peroneus tertius concerning prevention and treatment of ankle ligament injuries is low.1 In the two case it has been shown that the Peroneus tertius and the fourth digitations of extensor digitorium longus has a single belly and both muscle splits at the higher level than usual. Such type of muscular variation is not noticed yet and such variation helps in prevention of ankle ligament injury. The pull of the PT may be responsible for causing stress on the fifth metacarpal and account for all stress fractures in any individual.4 The presence of an anomalous m. Peroneus tertius tendon has also been described to be associated with a m. peroneus brevis tear. (5, 6) Peroneus brevis tear is one of the important cause of the chronic ankle pain.7

Conclusion:

Our human data indicate that during bipedalism peroneus tertius functions in concert with extensor digitorum longus and tibialis anterior as a swing-phase muscle in order to level the foot and help the toes clear the ground. The lack of support-phase activity in peroneus tertius contradicts suggestions that it acts primarily to support the lateral longitudinal arch and/or to transfer the foot's center of pressure medially while the font is in contact with the substrate. Lacking a peroneus tertius, our nonhuman subjects frequently recruited peroneus longus and peroneus brevis (plantar flexor/evertors) during swing phase. The acquisition of peroneus tertius in the hominid lineage has endowed us with a mechanically advantageous dorsiflexor/evertor that presumably improves the economy of human bipedalism.

Reference :

  1. Witvrouw EBorre KVWillems TMHuysmans JBroos EDe Clercq D:The significance of Peroneus tertius muscle in ankle injuries: a prospective study: Department of Rehabilitation Sciences and Physical Therapy, Faculty of Medicine and Health Sciences, Ghent University, Belgium. erik.witvrouw@ugent.be

  2. Joshi SD, Joshi SS Athavale SA: Morphology of Peroneus Tertius muscle: Department of anatomy,Rural Medical College, Loni, Ahmednagar, India.

  3. J Bertelli & Z Khoury:The Peroneus tertius island muscle flap: Journal of clinical anatomy;Sur. Clinical anat (1991) 13:243-244

  4. Das S, Haji Suhaimi F, Abd Latiff A, Pa Pa Hiaing K, Abd Ghafar N, Othman F: Absence of the Peroneus tertius muscle: cadaveric study with clinical considerations: Dept. of anatomy, Universiti Kebangsaan Malaysia, Kurala Lumpur, Malaysia, faizah@medic.ukm.my.

  5. 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.

  6. Sobel M, Mizel M. Injuries to the peroneal tendons. In: Pfeifer GB, Frey CC, editors. Current practice in foot and ankle surgery. Vol 1. New York: McGraw Hill; 1993. p. 30-6.

  7. Sobel M, Geppert MJ, Olson EJ, Bohne WH, 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.

This is a peer reviewed paper 

Please cite as: Chintan Rohitkumar Bhatt: Variation In Peroneus Teritius Tendon And Its Clinical Implications.

J.Orthopaedics 2010;7(2)e1

URL: http://www.jortho.org/2010/7/2/e1

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