Sergio Viana shared a beautiful companion case and open access podiatric article
Hi Hillary. It seems to be exceedingly rare(https://www.hmpgloballearningnetwork.com/site/podiatry/when-presence-flexor-hallucis-accessory-longus-contributes-chronic-foot-pain-standing), but I’ve seen this recently. Take a look at the attached image.
Em 10 de mai de 2024, às 17:15, hilary umans <hilary.umans> escreveu:
<51F heel pain 5916322ACPNY.jpg>
My colleague asked "can you have 2 FHLs"?
Not that I can find in the literature….there’s lots of normal variations with cross communication with the FDL….but this is distinctly separate from the FDL.
<51F heel pain 5916322ACPNY (1).jpg>
The FHL is medial, in blue
The extra muscle and tendon are just lateral to it at the ankle and inserts onto the anteromedial calcaneal body
<51F heel pain 5916322ACPNY (2).jpg>
<51F heel pain 5916322ACPNY (3).jpg>
<51F heel pain 5916322ACPNY (4).jpg>
Just to show the Achilles tendinosis and proximal plantar fasciopathy, which match her symptoms
The accessory muscle is the Peroneocalcaneus Internus (PCI) which has a 1% prevalence, arises from the distal fibula, lives deep to the flexor retinaculum and abuts the lateral aspect of the FHL muscle and tendon.
Apparently it can rarely cause symptoms, either by indirectly compression the NV bundle by way of mass effect on the FHL…or by friction between the PCI and FHL.
This is presumably asymptomatic and unrelated to her heel pain.
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