Elective neck dissection has long been a subject of debate among surgeons. The proponents of elective neck dissection base their rationale on studies that show a 30% incidence of occult disease in those situations for which elective neck dissection is recommended. One hundred eighty-two patients with advanced stages of squamous cell carcinoma of the head and neck were studied. All patients had preoperative computed tomography or magnetic resonance imaging, and all patients had some form of radical neck dissection. The sensitivity of clinical exam was compared with the sensitivity of computed tomography or magnetic resonance imaging in ability to detect nodal disease. The sensitivity of clinical exam alone was 71.7%, while the sensitivity of computed tomography or magnetic resonance imaging was 91.1%. Based on physical exam alone, there would be a 39% rate of occult disease; if computed tomography or magnetic resonance imaging data is combined with physical exam, the occult disease rate would drop to 12%. All centers performing elective neck dissection must reassess their rationale or restudy their occult disease rate with computed tomography or magnetic resonance imaging.

Atramatic, painful herniation of the abductor hallucis muscle is rare. During the period of writing this case study, we found less than ten published articles on abductor hallucis muscle anatomy and only three case reports on the abnormalities within the abductor hallucis muscle. Familiarity with the condition is needed for early diagnosis, surgical intervention, and prevention of recurrence. It is also important to have an experienced musculoskeletal radiologist to identify this unique pathology. This is a unique case study of a young active female who presented with an abductor hallucis muscle herniation, tarsal tunnel syndrome, and ligamentous laxity. She suffered from foot pain and was misdiagnosed for multiple years. She began living with normal foot pain during her exercise activities. Her symptoms began to worsen with numbness and tingling. After failing modification of shoe gear, physical therapy, resting, and offloading, she was further worked up with imaging. This MRI was evaluated by a musculoskeletal radiologist. It was discovered that she has a large muscle belly, with a retinaculum injury, and impingement along the tarsal tunnel. She was successfully treated with a surgical repair of the herniation, application of synthetic dynamic matrix graft, and decompression of the tarsal tunnel at the porta pedis. She had a complete resolution of symptoms in 6 weeks and she was followed up for 3 years with no recurrence. The purpose of this case report is to add to the body of literature on treatment options for muscle herniation in foot and ankle surgery.