Skip to main content
Log in

Peroneus quartus: prevalance and clinical importance

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

The most common variant muscle of the ankle, peroneus quartus muscle, is located in the lateral leg compartment. In literature there is ambiguous nomenclature of this muscle because of its different origin and insertion sides. It is related to many pathologic conditions in the lateral ankle compartment but also it can be used as a tendon graft for reconstructive procedures.

Material and method

We dissected 115 cadaver legs and investigated prevalence of peroneus quartus. We also present 2 year result of a patient who had torn superior peroneal retinaculum reconstructed with peroneus quartus tendon.

Results

The peroneus quartus muscle, with a number of different attachments, was present in 5.2 % (6/115) of the legs. It most commonly arose from the peroneus brevis muscle and inserted into the retrotrochlear eminence of the calcaneus. Associated pathologies are longitudinal degeneration and tear in the tendon of peroneus brevis. There is no any association between the prevalence of peroneus quartus and the height of retrotrochlear eminence or presence of peroneal tubercule (p > 0.05). But there is strong relationship between peroneus brevis degeneration and peroneus quartus existence (p: 0.03). We also defined a new type of peroneus quartus with a bifurcated insertion around the peroneus brevis. In literature our case report is unique because we present a patient who has torn superior peroneal retinaculum which is reconstructed with peroneus quartus tendon with 2 year follow up.

Conclusion

Peroneus quartus may lead to some pathologic conditions (pain, snapping, tear, synovitis, etc.) in the lateral ankle compartment but it may be used to reconstruct some pathologic conditions. Orthopaedics, anatomists and radiologists should be aware of this accessory tendon structure because of its clinical importance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Hecker P (1923) Study of the peroneus of the tarsus. Anat Rec 26:79–82

    Article  Google Scholar 

  2. Choudhary S, McNally E (2011) Review of common and unusual causes of lateral ankle pain. Skelet Radiol 40:1399–1413

    Article  Google Scholar 

  3. Sarrafian SK (2011) In: AS Kelikian (ed) Sarrafian’s anatomy of the foot and ankle: descriptive, topographic, functional, 3rd edn. Lippincott, Williams & Wilkins, Philadelphia, p 240–245

  4. Zammit J, Singh D (2003) The peroneus quartus muscle anatomy and clinical relevance. JBJS Br 8:1134–1137

    Article  Google Scholar 

  5. Clarkson MJ, Fox JN, Atsas S, Daney BT, Dodson SC, Lambert HW (2013) Clinical implications of novel variants of the fibularis (peroneus) quartus muscle inserting onto the cuboid bone: peroneocuboideus and peroneocalcaneocuboideus. J Foot Ankle Surg 52:118–121

    Article  PubMed  Google Scholar 

  6. Sobel M, Geppert MJ, Olson EJ, Bohne WHO, Arnoczky SP (1992) The dynamics of peroneus brevis tendon splits: a proposed mechanism, technique of diagnosis and classification of injury. Foot Ankle 13:413–422

    Article  CAS  PubMed  Google Scholar 

  7. Murlimanju BV, D’Souza PS, Prabhu LV, Saralaya VV, David SJ (2012) Peroneus quartus, an accessory muscle in human: case report and its clinical importance. Clin Ter 163(4):307–309

    CAS  PubMed  Google Scholar 

  8. Tubbs RS, May WR, Shoja MM, Loukas M, Salter EG, Oakes WJ (2008) Peroneotalocalcaneus muscle. Anat Sci Int 83(4):280–282

    Article  PubMed  Google Scholar 

  9. Sobel M, Levy ME, Bohne WH (1990) Congenital variations of the peroneus quartus muscle: an anatomic study. Foot Ankle 11:81–89

    Article  CAS  PubMed  Google Scholar 

  10. Prakash, Narayanswamy C, Singh DK, Rajini T, Venkatiah J, Singh G (2011) Anatomical variations of peroneal muscles: a cadaver study in an Indian population and a review of the literature. J Am Podiatr Med Assoc 101(6):505–508

    CAS  PubMed  Google Scholar 

  11. Sammarco GJ, Brainard JB (1991) A symptomatic anomalous peroneus brevis in a high-jumper: a case report. J Bone Joint Surg Am 73-A:131–133

    Google Scholar 

  12. Trono M, Tueche S, Quintart C, Libotte M, Baillon JM (1999) Peroneus quartus muscle: a case report and review of the literature. Foot Ankle Int 10:659–662

    Article  Google Scholar 

  13. Uğurlu M, Bozkurt M, Demirkale I, Cömert A, Acar HI, Tekdemir I (2010) Anatomy of the lateral complex of the ankle joint in relation to peroneal tendons, distal fibula and talus: a cadaveric study. Eklem Hastalik Cerrahisi 21(3):153–158

    PubMed  Google Scholar 

  14. Hammerschlag WA, Goldner JL (1989) Chronic peroneal subluxation produced by an anomalous peroneus brevis: case report and literature review. Foot Ankle 10:45–47

    Article  CAS  PubMed  Google Scholar 

  15. Mick CA, Lynch F (1987) Reconstruction of the peroneal retinaculum using peroneus quartus: a case report. J Bone Joint Surg Am 69-A:296–297

    Google Scholar 

  16. Yong CK (2006) Peroneus quartus and peroneal tendoscopy. Med J Malaysia 61(Suppl B):45–47

    PubMed  Google Scholar 

  17. Lepow GM, Korfin DH (1985) Calcification of an accessory peroneal tendon in an athlete: a case presentation. J Am Podiatr Med Assoc 75:323–325

    CAS  PubMed  Google Scholar 

  18. Wachter S, Beekman S (1983) Peroneus quartus: a case report. J Am Podiatry Assoc 73:523–524

    CAS  PubMed  Google Scholar 

  19. Wang XT, Rosenberg ZS, Mechlin MB, Schweitzer ME (2005) Normal variants and diseases of the peroneal tendons and superior peroneal retinaculum: MR imaging features. Radiographics 25(3):587–602

    Article  PubMed  Google Scholar 

  20. Brandes CB, Smith RW (2000) Characterisation of patients with primary peroneus longus tendinopathy: review of twenty two cases. Foot Ankle Int 21:462–468

    CAS  PubMed  Google Scholar 

  21. Cheung YY, Rosenberg ZS, Ramsinghani R, Beltran J, Jahss MH (1997) Peroneus quartus muscle: MRI imaging features. Radiology 202:745–750

    CAS  PubMed  Google Scholar 

  22. Wood J (1866) Variations in human myology observed during the winter session of 1865–1866 at King’s College London. Proc R Soc Lon 16:229–244

    Article  Google Scholar 

  23. Wood J (1868) Variations in human myology observed during the winter session of 1867–1868 at King’s College London. Proc R Soc Lond 16:483–525

    Article  Google Scholar 

  24. Pozzi S (1872) Sur une vari_et_e fr_equente du muscle court p_eronier lateral chez l’homme (anomalie reversive). Bull Soc Anthrop Paris 2:155–161

    Article  Google Scholar 

  25. Gruber W (1879) Mongraphie €uber den musculus peronaeus digiti V and sein reduktionen USW bei dem s€angetieren. Beobachtungen aus der Menschlichen und Vergleichenden Anatomie H VII:35–80

  26. Chaney DM, Lee, Khan MA, KruegerWA, Mandracchia VJ, Yoho RM (1996) Study of ten anatomical variants of the foot and ankle. J Am Podiatr Med Assoc 86:532–537

    CAS  PubMed  Google Scholar 

  27. Rosenberg ZS, Beltran J, Cheung YY, Colon E, Herraiz F (1997) MR features of longitudinal tears of the peroneus brevis tendon. AJR Am J Roentgenol 168:141–147

    Article  CAS  PubMed  Google Scholar 

  28. Chepuri NB, Jacobson JA, Fessell DP, Hayes CW (2001) Sonographic appearance of the peroneus quartus muscle: correlation with MR imaging appearance in seven patients. Radiology 218:415–419

    Article  CAS  PubMed  Google Scholar 

  29. Borne J, Fantino O, Besse JL, Clouet P, Tran Minh V (2002) Aspect IRM des variantes anatomiques des muscles, tendons et ligaments de la cheville. J Radiol 83:27–38

    CAS  PubMed  Google Scholar 

  30. Saupe N, Mengiardi B, Pfirrmann CW, Vienne P, Seifert B, Zanetti M (2007) Anatomicvariants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles. Radiology 242:509–517

    Article  PubMed  Google Scholar 

  31. Athavale SA, Gupta V, Kotgirwar S, Singh V (2012) The peroneus quartus muscle: clinical correlation with evolutionary importance. Anat Sci Int 87:106–110

    Article  PubMed  Google Scholar 

  32. Nascimento SRR, Costa RW, Ruiz CR, Wafae N (2012) Analysis on the incidence of the fibularis quartus muscle using magnetic resonance imaging. Anat Res Int 485149

Download references

Acknowledgments

We thank Olgar Birsel MD for illustriation.

Conflict of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mustafa Gökhan Bilgili.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bilgili, M.G., Kaynak, G., Botanlıoğlu, H. et al. Peroneus quartus: prevalance and clinical importance. Arch Orthop Trauma Surg 134, 481–487 (2014). https://doi.org/10.1007/s00402-014-1937-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-014-1937-4

Keywords

Navigation