Case Report
International Journal of Anatomical Variations (2013) 6: 20–21 eISSN 1308-4038
A cadaveric report of unilateral fibularis tertius in absentia: a clinical perspective
Introduction
Fibularis tertius (FT), formerly known as peroneus tertius is
a unique muscle in human being, often considered as a fifth
tendon of extensor digitorum longus. The muscle originates
from the distal one third or medial fibular surface, anterior
surface of the interosseous membrane and anterior crural
intermuscular septum. Thereafter, the tendon runs beneath
the superior extensor retinaculum, inferior extensor
retinaculum and gets inserted into dorsal surface of fifth
metatarsal. Fibularis tertius is supplied by deep peroneal
nerve and assists in dorsiflexion of foot in swing phase and
evertion of foot [1]. Vertullo et al. considered its insertion site
as an important factor in case of Jones fracture [2]. A study
conducted by Joshi et al. concluded that muscle might remain
rudimentary or even absent in 4.4-10% cases in humans [3].
Another similar study carried out on Caucasian population
showed its absence in 5-17% of cases studied [4].
Case Report
During routine dissection curriculum for undergraduate
teaching, we have come across a rare finding of absence of
FT unilaterally in formalin fixed male cadaver. Dissection
was carried out on both right and left lower limbs using
Cunningham’s manual of practical anatomy. Both the limbs
were carefully observed and examined to differentiate the
absence of FT muscle. There was no mark of external injury
or operational scar on the limbs. No relevant sign of existence
of the muscle was noticed on left limb whereas right limb was
showing its presence. Relationship of extensor digitorum
longus tendon (EDL) was noticed with neighboring structures
on extensor compartment which revealed following relations
medial to lateral: tibialis anterior, extensor hallucis longus,
anterior tibial artery, deep peroneal nerve and extensor
digitorum longus. Photographic record of the dissected limbs
was documented (Figure 1).
Discussion
FT occupies the extensor compartment of leg and assists
in dorsiflexion of foot in swing phase and eversion of foot
[1]. Study conducted by Soames et al. revealed minimal
functional importance of FT since its action is superimposed
by actions of other muscles. It has significant influence
on neuromuscular control and in prevention of talofibular
ligament injuries [5]. Jungers et al. suggested that presence
of the FT muscle is in close relation with the development of
EDL muscle [6]. Local thickening of fourth tendon of EDL
may be expected in case of absent FT [7]. A gender based
comparative study was performed to describe its prevalence
stating that the rate of its existence was higher in men [5].
Alok SAXENA
[1]
Biswabina RAY
[2]
Snigdha MISHRA
[2]
Vivekanandan PERUMAL
[3]
Department of Anatomy, Veer Chandra Singh Garhwali
Government Medical Science and Research Institute,
Srinagar, Uttarakhand [1], Department of Anatomy, MMMC,
Manipal University, Karnataka [2], INDIA, Department of
Anatomy, University of Otago, NEW ZEALAND [3].
Alok Saxena
Senior Demonstrator
Department of Anatomy
Veer Chandra Singh Garhwali
Government Medical Science and
Research Institute
Srinagar, Uttarakhand, INDIA.
+91 989 7699599
drsan_99@rediffmail.com
Received November 10th, 2011; accepted September 8th, 2012
Abstract
Fibularis tertius is a muscle of anterior compartment of leg, often considered as a part of extensor
digitorum longus. This muscle contributes to dorsiflexion and eversion of foot. Existence of this
muscle in many primates and in humans is still a topic of discussion. Previous reports show many
variations on its existence. During routine dissection in the Department of Anatomy we came
across an incidental finding of absence of fibularis tertius unilaterally. Clinical importance and
functional significance of absence of fibularis tertius is discussed herein.
© Int J Anat Var (IJAV). 2013; 6: 20–21.
Key words [dorsiflexion] [eversion] [extensor digitorum longus] [fibularis tertius]
Published online February 5th, 2013 © http://www.ijav.org