Article

Physical and rehabilitation medicine physicians commonly see
patients with chronic functional ankle instability.
The main anatomical
structures involved in ankle stability are the peroneus (fibularis) brevis and
peroneus longus muscles. Several anatomical muscle-tendon variations have been
described in the literature as being sometimes responsible for this instability,
the peroneus quartus muscle being the most frequent.
The objective of this
clinical study is to discuss the implication of the bilateral peroneus quartus
muscle in functional ankle instability. CLINICAL CASE:
This 26-year-old patient
was seen in PM&R consultation for recurrent episodes of lateral ankle sprains.
The clinical examination found a moderate hyperlaxity on the right side in
bilateral ankle varus. We also noted a bilateral weakness of the peroneus
muscles. Additional imaging examinations showed a supernumerary bilateral
peroneus quartus. The electroneuromyogram of the peroneus muscles was normal.
DISCUSSION: In the literature the incidence of a supernumerary peroneus quartus
muscle varies from 0 to 21.7%. Most times this muscle is asymptomatic and is only
fortuitously discovered. However some cases of chronic ankle pain or instability
have been reported in the literature. It seems relevant to discuss, around the
clinical case of this patient, the impact of this muscle on ankle instability
especially when faced with lingering weakness of the peroneus brevis and longus
muscles in spite of eccentric strength training and in the absence of any
neurological impairment. One of the hypotheses, previously described in the
literature, would be the overcrowding effect resulting in a true conflict by
reducing the available space for the peroneal muscles in the peroneal sheath.
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Langue : ANGLAIS ; FRANCAIS