Surgical Management of the Peroneus Quartus Muscle for Bilateral Ankle Pain
In this study, the authors presented a rare case of bilateral ankle pain with crepitation caused by the peroneus quartus (PQ) muscle.
A 16-year-old adolescent had played soccer since childhood. For 2 years before the consult, he sometimes noted mild pain with crepitation in both of his ankles during walking.
He continued to observe these symptoms although they were very weak, and he noted them only while playing soccer.
The year before the consult, he twisted his right ankle while playing volleyball and sustained strong right ankle pain with crepitation.
Physical examination revealed tenderness in the anteromedial and posterolateral right ankle, but no obvious swelling or local heat was observed at these sites.
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He noted that the tenderness increased with right ankle dorsiflexion. Right ankle instability was also observed on varus force.
He noted tenderness in the posterolateral left ankle during exercise.
Radiographs and computed tomographic scans revealed impingement exostoses as bone spurs in the anterior of the tibial plafond and the neck of the talus.
Magnetic resonance imaging (MRI) showed that his anterior talofibular ligament (ATFL) was intact but very thin.
The cause of the patient’s symptoms was derived from the PQ muscle using MRI and intraoperative findings. However, the right ankle symptoms continued after the first operation.
The authors believed that the reason for this was adhesion in the tendon sheath and a disorder of tendon movement caused by long casting.
The authors also believed that the patient’s postoperative crutch gait put a strain on the left ankle and triggered the symptoms.
Therefore, the authors advocated rehabilitation involving ankle range of motion at the earliest to prevent complications post-operation.
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References:
- Chinzei. N., Kanzaki, N., Takakura, Y., Takakura, Y., Toda, A., Fujishiro, T., Hayashi, S., Hashimoto, S., Kuroda, R., Kurosaka, M. (2015) Surgical Management of the Peroneus Quartus Muscle for Bilateral Ankle Pain. Journal of the American Podiatric Medical Association: January/February 2015, Vol. 105, No. 1, pp. 85-91
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