Congenital Variations of the Peroneus Quartus Muscle: An Anatomic Study

Abstract

There has been little research concerning this muscle since the 1920s, when Hecker described this muscle to be present in (13%) of his dissections of cadaver legs. The purpose of our dissections was to establish the incidence of the peroneus quartus muscle, its origins, and insertions. One hundred and twenty-four legs from 65 fresh human cadavers were dissected under loupe magnification. When the peroneus quartus tendon was found, its origin, insertion, and anatomic relationship to the peroneus longus and peroneus brevis were observed. All specimens were sketched and photographed. The peroneus quartus muscle was present in 27 legs (21.7% of specimens). Its origins, insertions, and size varied. In 17 legs (63%) the muscle originated from the muscular portion of the peroneus brevis, and inserted on the peroneal tubercle of the calcaneus. The peroneal tubercle was hypertrophied at the insertion in most cases. The results of this study in general show that there was much higher incidence of the peroneus quartus muscle than Hecker claimed. Its course, origin, and insertion varied. Its tendon can be used for reconstructive procedures about the lateral aspect of the ankle, especially in anterior dislocation of the peroneal tendons and reconstruction of lateral ligaments.

Accessory Tendon and Tripartite Insertion Pattern of Fibularis Longus Muscle: A Case Report

“…The fourth fibularis muscle as member of a group of accessory fibular muscles has been described as to be unique to humans (Henle, 1871). This supernumerary muscle originates as a slip high up on the fibula between the longus and brevis fibular muscles or from distal part of leg and the distal attachments of the muscle are not fixed (Macalister, 1875;Hecker;Sobel, 1990).The origin of the fibularis quartus from the posterior aspect of the fibula between the brevis and flexor hallucis longus muscles was described (Wachter & Beekman). The fibularis quartus muscle represents an evolutionary step in the development of bipedal posture (Hecker).…”

Varyant İnsersiyonlu Peroneus Quartus: Bir Olgu Sunumu

“…They showed that it was present in 21.7% of cadavers. The most frequent origin was from the muscle fibres of PB and its most frequent insertion was into the retrotrochlear eminence of the calcaneum.The PQ muscle although usually stems from the peroneus brevis; however some cases of emergence from the PL were also reported i.e., 15% of cases for Sobelet al 5 . In the present case, PQ was found to arise both from the PB and PL.…”

“…In different cases of patients with chronic pain and swelling around the ankle after lateral ankle sprain, the surgical exploration revealed the presence of PQ muscle and after conservative treatments failed, surgical resection was found to be more effective treatment 14 . In spite of its shortcomings, the PQ muscle has been used successfully in the reconstruction of the peroneal retinaculum for the treatment of recurrent anterior subluxations of the peroneal tendons and has thus proved to be beneficial 5,15 .…”

Peroneus Quartus Muscle: Its Incidence and Clinical Importance

“…The peroneus quartus muscle was first described by Otto in 1816 [3] and has since been termed the peroneus sextus, peroneus calcaneus externus, peroneocuboidian, peroneus accessorius, peroneus medius [7], and peroneus muscle of the tarsus [1]. Anatomists, surgeons, and radiologists have discovered slight variations in the distal insertion of the peroneus quartus, resulting in both increased and ambiguous nomenclature [8][9][10][11]. The reported points of insertion include (from proximally to distally): retrotrochlear eminence of the calcaneus, the fibular (peroneal) trochlea of the calcaneus, tendons of the fibularis longus and brevis muscles, the cuboid, and the fifth metatarsal [10,[12][13][14].…”

“…Anatomists, surgeons, and radiologists have discovered slight variations in the distal insertion of the peroneus quartus, resulting in both increased and ambiguous nomenclature [8][9][10][11]. The reported points of insertion include (from proximally to distally): retrotrochlear eminence of the calcaneus, the fibular (peroneal) trochlea of the calcaneus, tendons of the fibularis longus and brevis muscles, the cuboid, and the fifth metatarsal [10,[12][13][14]. In 1923, Hecker [1] classified the peroneus quartus variants into 3 categories according to the insertion onto the calcaneus (peroneocalcaneus externum), cuboid (peroneocuboideus), or tendon of peroneus longus (peroneoperoneolongus).…”