Anatomical Science International

, Volume 84, Issue 3, pp 257–263 | Cite as

An unusual variation of the flexor digitorum accessorius longus muscle—its anatomy and clinical significance

Case Report

Abstract

In this article we describe a variant accessory muscle found in the deep posterior compartment of the leg in a 96 year-old female human cadaver. The flexor digitorum accessorius longus was found bilaterally, originating by two heads from the shafts of the tibia and fibula. The two heads of the muscle were observed to be subequal in size and none of the fleshy fibers of the muscle entered the tarsal tunnel. This stands in contrast with previous descriptions of accessory digital flexors, which are typically asymmetrical or single-headed, and which almost always introduce fleshy fibers into the tarsal tunnel. This variant structure has the potential to entrap the tibial nerve and compress the posterior tibial vessels either proximal to the talocrural joint or within the tarsal tunnel, and may be implicated in clinical scenarios involving imaging, surgery, compartment syndromes, or deep-vein thromboses.

Keywords

Accessory muscle Anatomical variation Bipennate Flexor digitorum accessorius longus Tarsal tunnel 

References

  1. Brodie JT, Dormans JP, Gregg JR, Davidson RS (1997) Accessory soleus muscle. Clin Orthop Relat Res 337:180–186PubMedCrossRefGoogle Scholar
  2. Buckingham RA, Winson IG, Kelly AJ (1997) An anatomical study of a new portal for ankle arthroscopy. J Bone Joint Surg Br 79:650–652PubMedCrossRefGoogle Scholar
  3. Burks JB, DeHeer PA (2001) Tarsal tunnel syndrome secondary to an accessory muscle: a case report. J Foot Ankle Surg 40:401–403PubMedCrossRefGoogle Scholar
  4. Buschmann WR, Cheung Y, Jahss MH (1999) Magnetic resonance imaging of anomalous leg muscles: accessory soleus, peroneus quartus and the flexor digitorum longus accessorius. Foot Ankle Int 12:109–116Google Scholar
  5. Canter DE, Siesel KJ (1997) Flexor digitorum accessorius longus muscle: an etiology of tarsal tunnel syndrome? J Foot Ankle Surg 36:226–229PubMedCrossRefGoogle Scholar
  6. Deroy AR, Clause CC, Baskin ES, Bauer GR (2002) Recognition of the flexor digitorum accessorius longus. J Am Podiatr Med Assoc 92:463–466PubMedGoogle Scholar
  7. Driver JR, Denison AB (1914) The morphology of the long accessorius muscle. Anat Rec 8:341–347CrossRefGoogle Scholar
  8. Eberle CF, Moran B, Gleason T (2002) The accessory flexor digitorum longus as a cause of flexor hallucis syndrome. Foot Ankle Int 23:51–55PubMedGoogle Scholar
  9. Gümüşalan Y, Kalaycioğlu A (2000) Bilateral accessory flexor digitorium longus muscle in man. Ann Anat 182:573–576PubMedCrossRefGoogle Scholar
  10. Jaijesh P, Shenoy M, Anuradha L, Chithralekha KK (2006) Flexor accessorius longus: a rare variation of the deep extrinsic digital flexors of the leg and its phylogenetic significance. Indian J Plast Surg 39:169–171CrossRefGoogle Scholar
  11. Kinoshita M, Okuda R, Morikawa J, Abe M (2003) Tarsal tunnel syndrome associated with an accessory muscle. Foot Ankle Int 24:132–136PubMedGoogle Scholar
  12. Lau JTC, Daniels TR (1999) Tarsal tunnel syndrome: a review of the literature. Foot Ankle Int 20:201–209PubMedGoogle Scholar
  13. Liu PT, Moyer AC, Huettl EA, Fowl RJ, Stone WM (2005) Popliteal vascular entrapment syndrome caused by a rare anomalous slip of the lateral head of the gastrocnemius muscle. Skeletal Radiol 34:359–363PubMedCrossRefGoogle Scholar
  14. Madhavi C, Holla SJ (2003) Anomalous flexor digiti minimi brevis in Guyon’s canal. Clin Anat 16:340–343PubMedCrossRefGoogle Scholar
  15. Moore KL, Dalley AF (2006) Clinically oriented Anatomy, 5th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  16. Nathan H, Gloobe H, Yosipovitch Z (1975) Flexor digitorum accessorius longus. Clin Orthop Relat Res 113:158–161PubMedCrossRefGoogle Scholar
  17. Peterson DA, Stinson W, Lairmore JR (1995) The long accessory flexor muscle: an anatomical study. Foot Ankle Int 16:637–640PubMedGoogle Scholar
  18. Sammarco GJ, Conti SF (1994) Tarsal tunnel syndrome caused by an anomalous muscle. J Bone Joint Surg Am 76:1308–1314PubMedGoogle Scholar
  19. Sammarco GJ, Stephens MM (1990) Tarsal tunnel syndrome caused by the flexor digitorum accessorius longus. A case report. J Bone Joint Surg Am 72:453–454PubMedGoogle Scholar
  20. VanCourt RB, Siesel KJ (1996) Flexor digitorum accessorius longus muscle. J Am Podiatr Med Assoc 86:559–560PubMedGoogle Scholar
  21. Wittmayer BC, Freed L (2007) Diagnosis and surgical management of flexor digitorum accessorius longus-induced tarsal tunnel syndrome. J Foot Ankle Surg 46:484–487PubMedCrossRefGoogle Scholar
  22. Wood J (1864) On some varieties in human myology. Proc R Soc Lond 13:299–303Google Scholar
  23. Wood J (1866) Variations in human myology observed during the Winter Session of 1865–66 at King’s college, London. Proc R Soc Lond 15:229–244CrossRefGoogle Scholar
  24. Wood J (1867) Variations in human myology observed during the winter session of 1866–67 at King’s college, London. Proc R Soc Lond 15:518–546Google Scholar
  25. Wood J (1868) Variations in human myology observed during the winter session of 1867–68 at King’s college, London. Proc R Soc Lond 16:483–525Google Scholar

Copyright information

© Japanese Association of Anatomists 2009

Authors and Affiliations

  1. 1.Department of AnatomyNew York College of Osteopathic MedicineOld WestburyUSA

Personalised recommendations