Abstract
Musculoskeletal anatomy is widely known to have components that stray from the norm
in the form of variant muscle and tendon presence, absence, origin, insertion, and
bifurcation. Although these variant muscles and tendons might be deemed incidental
and insignificant findings by most, they can be important contributors to pathologic
physiology or, more importantly, an option for effective treatment. In the present
case report, we describe a patient with phocomelia and Müllerian abnormalities secondary
to in utero thalidomide exposure. The patient had experienced recurrent bilateral
foot pain accompanied by numbness, stiffness, swelling, and longstanding pes planus.
These symptoms persisted despite conservative treatment with orthotics, steroids,
and nonsteroidal anti-inflammatory drugs. Radiographic imaging showed dysmorphic and
degenerative changes of the ankle and foot joints. Further investigation with magnetic
resonance imaging revealed complex anatomic abnormalities, including the absence of
the posterior tibialis and peroneus brevis, lateralization of the peroneus longus,
and the presence of a variant anterior compartment muscle. The variant structure was
likely a previously described anterior compartment variant, anterior fibulocalcaneus,
and might have been a source of the recurrent pain. Also, the absence of the posterior
tibialis might have caused the pes planus in the present patient, considering that
posterior tibialis tendon dysfunction is the most common cause of acquired pes planus.
Although thalidomide infrequently affects the lower extremities, its effects on growth
and development were likely the cause of this rare array of anatomic abnormalities
and resulting ankle and foot pathologic features.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: August 14, 2017
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2017 by the American College of Foot and Ankle Surgeons. All rights reserved.
