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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
Olewnik et al. (2019b) studied the insertion of fibularis brevis in 102 lower limbs. In 72 cases (70.6%), the tendon had a single insertion onto the base of the fifth metatarsal. In 30 cases (29.4%), the tendon had a bifurcated attachment with the main tendon having a normal insertion onto the fifth metatarsal. In 23 cases (22.5%), the accessory tendon inserted onto the dorsal surface of the base of the fifth metatarsal. In five cases (4.9%), the accessory tendon sent a band to the dorsal surface of the base of the fifth metatarsal and a band to the shaft of the fifth metatarsal. In two cases (2%), the accessory tendon sent a band to the dorsal surface of the base of the fifth metatarsal while another band fused with fibularis tertius and gave origin to the fourth dorsal interosseous muscle.
The Stomach (ST)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Clinical Relevance: The trigger point associated with the fibularis brevis muscle occurs in the vicinity of ST 40. The referred pain pattern issues to the lateral malleolus and along the lateral aspect of the dorsum of the foot. More distal trigger points in the fibularis brevis instead focus on the anterior angle and posterolateral heel.
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).