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Lower Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Malynda Williams
Extensor hallucis brevis is regarded as a distinct medial slip of extensor digitorum brevis (Standring 2016). This muscle thus originates from the superolateral surface of the distal calcaneus, from the interosseous talocalcaneal ligament, and from the deep aspect of the base of the inferior extensor retinaculum (Standring 2016). Its tendon inserts onto the dorsal surface of the base of the proximal hallucal phalanx (Standring 2016).
Lower limb
Published in David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings, McMinn’s Concise Human Anatomy, 2017
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings
Extensor digitorum brevis - the only muscle of the dorsum of the foot, from the dorsal surface of the calcaneus it gives off tendons that join the hallucis and digito- rum tendons to the four medial toes. The part going to the great toe is sometimes called the extensor hallucis brevis. It is innervated by the deep fibular (peroneal) nerve.
The Foot
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
The extensor digitorum muscle arises from the lateral and distal portions of the calcaneus. The most medial portion of this muscle is commonly named the extensor hallucis brevis, inserting upon the great toe. The extensor digitorum brevis gives off slender tendons to the second, third and fourth toes. These tendinous slips join the tendons of the extensor digitorum longus for those digits.
Impact of combining medial capsule interposition with modified scarf osteotomy for hallux valgus
Published in Modern Rheumatology, 2020
Kosuke Ebina, Makoto Hirao, Hideki Tsuboi, Shoichi Kaneshiro, Masataka Nishikawa, Atsushi Goshima, Takaaki Noguchi, Hiroyuki Nakaya, Yuki Etani, Akira Miyama, Kenji Takami, Jun Hashimoto, Hideki Yoshikawa
Concerning interposition techniques, many previous reports demonstrated their efficacy in the treatment of hallux rigidus. Hamilton et al. demonstrated suturing the extensor hallucis brevis tendon to the flexor hallucis brevis tendon [16] and Aynardi et al. demonstrated good outcomes for the same procedure (patient-reported outcome was good or excellent in 89.5%, with mean follow-up of 62.2 months) [5]. Recently, Vulcano et al. also reported the good-long term outcomes (patient satisfaction of 92.9%, with a mean follow-up of 11.3 years) of this procedure [6], suggesting the long-term efficacy of capsular interposition. A previous report demonstrated that interpositioned-capsule remained as fibrocartilage tissue by biopsy examination [5], which may contribute to pain reduction and improvement of range of motion by preserving sliding surface of articular cartilage in this study.
Ultrasound-guided injections of amniotic membrane/umbilical cord particulate for painful neuropathy of the lower extremity
Published in Cogent Medicine, 2020
All patients received ultrasound-guided injection at the common peroneal nerve at the knee, posterior tibial nerve at the ankle, and deep peroneal nerve on the dorsalateral foot. For injection of the common peroneal nerve (Figure 1), the patient was in the lateral decubitus position with the affected side up. The common peroneal nerve was found using a 7.5- to 15-Hz ultrasound probe (Sonoscape S9, Universal Medical Systems, Bedford Hills, NY) by scanning distally from the sciatic nerve in the proximal thigh and toward the proximal fibula. A diagnostic injection of 1cc of 1% lidocaine plain (Hikma Pharmaceuticals, London, United Kingdom) and 0.5cc of 8.4% sodium bicarbonate (Fresenius Kabi, Lake Zurich, IL) was performed for superficial anesthesia. Then, 25 mg of AM/UC particulate (CLARIX FLO®, Amniox Medical, Inc., Miami, FL) pre-mixed with 1.0 cc of 0.5% Marcaine plain (Fresenius Kabi, Lake Zurich, IL) in a 25-gauge, 1.5-inch needle was inserted via out-of-plane approach. The needle tip was positioned deep to the nerve to ensure adequate circumferential and proximal perineural distribution of the injectate outside the epinerium of the nerve. Needle repositioning was performed as needed to ensure complete coverage. Injection of the posterior tibial nerve at the ankle was performed with the patient in Fowler’s position with the lateral foot down to expose the medial side of the hindfoot (Figure 2). The nerve was located using the ultrasound probe placed obliquely along the malleolar-calcaneal axis, with the notch toward the medial malleolus and the other end directed toward the heel. After visualization of the tibial nerve, 3cc of local anesthetic (plain 1% lidocaine and 8.4% sodium bicarbonate) was injected. Thereafter, injection of 50 mg AM/UC particulate pre-mixed with 1.5 cc of 0.5% Marcaine plain (Fresenius Kabi, Lake Zurich, IL) was performed using a 22-gauge B-beveled block needle using in-plane technique. Lastly, injection of the lateral branch of the deep peroneal nerve was performed distal to the anterolateral part of the talus head and beneath the extensor hallucis brevis (Figure 3). Local anesthetic (1cc plain 1% lidocaine and 0.5cc 8.4% sodium bicarbonate) was first provided for superficial anesthesia. Then, injection of 1.0 cc of 25 mg AM/UC particulate/Marcaine was performed to surround the nerve completely using in-plane ultrasound guidance with a 22-gauge, 50-mm-long Stimuplex needle. All patients remained in the office for 15 min after the injection to be monitored for adverse reactions. Afterwards, they were asked to avoid any strenuous activity for at least 24 h and ice the injected region as needed for post-injection pain up to 72 h. Patients were also asked to elevate the foot for 2 days and stop the use of anti–inflammatory medications for a duration of 5 days post-injection.
Great toe drop following knee ligament reconstruction: A case report
Published in Physiotherapy Theory and Practice, 2020
David A Boyce, Chantal Prewitt
At the apex of the popliteal fossa, the sciatic nerve (L4-S3 ventral rami) splits into a CFN laterally and a tibial nerve medially. Proximally, the CFN is located between the tendon of the biceps femoris and the lateral head of the gastrocnemius muscle, which then wraps around the fibular neck and enters the fibular tunnel deep to fibularis longus muscle before splitting into the superficial fibular nerve (SFN) and deep fibular nerve (DFN). The DFN innervates the anterior compartment muscles of the leg: tibialis anterior (TA), EDL, EHL, and peroneus tertius. As it descends, the DFN travels between the EDL and TA proximally, then between the EHL and TA distally before crossing the ankle to provide motor innervation to the EDB and extensor hallucis brevis muscles as well as cutaneous innervation to the skin between the first and second toes (Figures 1 and 2). The SFN innervates the lateral compartment muscles of the leg (i.e., fibularis longus and fibularis brevis) and ends distally as the cutaneous SFN to provide sensory innervation to the dorsum of the foot with the exception of the skin between the first two toes (Dumitru, Amato, and Zwarts, 2002; Jenkins, 2008). It should also be noted that about 28% of individuals have an accessory fibular nerve branch of the SFN that supply the EDB (Dumitru, Amato, and Zwarts, 2002; Kimura, 2001; Preston and Shapiro, 2013). Incidence of nerve injury after knee arthroscopy is reported as occurring at a rate of 0.06–2.5% (Sanders, Rolf, McClelland, and Xerogeanes, 2007; Small, 1986, 1988). Of those, the most commonly injured mixed nerve is the CFN (Small, 1986). Consequently, knowing the anatomical pathway of the CFN and its branches provides a better understanding of the potential risks for nerve injury. Research has shown that there are variations in the anatomical location where CFN is split into two main branches. The split can be proximal to the knee joint (10%) or inferior to the knee joint but proximal to the fibular neck (8.6%) (Deutsch, Wyzykowski, and Victoroff, 1999). Anatomical variations in nerve distribution can consequently increase the risk of nerve damage during knee arthroscopy. Reports on injury to the DFN after arthroscopic surgery were linked with an anatomical variation of the CFN as it is divided into the DFN and SFN proximal to the fibular head instead of its standard split distal to the fibular neck (Deutsch, Wyzykowski, and Victoroff, 1999; Rodeo, Sobel, and Weiland, 1993). We could speculate that such anatomical difference was a possible cause of the postsurgery problems observed in this case report. Complications such as CFN palsy can result as this nerve is also superficial thus more prone to injury (Ryan et al., 2003; Steward, 2008). Additionally, procedures involving proximal fibula and tibia osteotomies or fibular graft harvest have resulted in foot drop due to injured CFN or DFN (Bauer et al., 2005; Gibson, Barnes, Allen, and Chan, 1986; Kirgis and Albrecht, 1992; Shingade, Jagtap, and Ranade, 2004). However, paralysis of just one muscle innervated by the DFN after knee arthroscopy remains a rare occurrence as it has only been reported once in the literature (Estrella and Eufemio, 2008).