Case Report| Volume 58, ISSUE 4, P653-656, July 2019

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M. Peroneus Quartus Causing Chronic Peroneal Compartment Syndrome in a Runner Treated by Endoscopic Fasciotomy: A Case Report


      We present the rare case of a 47-year-old male long-distance runner who was referred to our hospital with a longstanding pain in his left calf. Clinical history, as well as ultrasound and magnetic resonance imaging scans, showed an accessory peroneal muscle. This muscle was identified as a peroneus quartus muscle. On ultrasound, controlled intracompartmental pressure measurement, a chronic peroneal compartment syndrome, was diagnosed. We performed an endoscopic-assisted fasciotomy of the peroneal compartment. This resolved the patient's symptoms completely and allowed the runner to return to competition shortly after the surgery.

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        • Sobel M
        • Levy ME
        • Bohne WH
        Congenital variations of the peroneus quartus muscle: an anatomic study.
        Foot Ankle Int. 1990; 11: 81-89
        • Yammine K
        The accessory peroneal (fibular) muscles: peroneus quartus and peroneus digiti quinti. A systematic review and meta-analysis.
        Surg Radiol Anat. 2015; 37: 617-627
        • Zammit J
        • Singh D
        The peroneus quartus muscle.
        J Bone Jt Surg. 2003; 85: 1134-1137
        • Öznur A
        • Arik A
        • Alanay A
        Peroneus quartus muscle as a rare cause of the chronic lateral ankle pain.
        Foot Ankle Surg. 2002; 8: 227-230
        • Opdam KTM
        • van Dijk PAD
        • Stufkens SAS
        • van Dijk CN
        The peroneus quartus muscle in a locking phenomenon of the ankle: a case report.
        J Foot Ankle Surg. 2017; 56: 108-111
        • Mick CA
        • Lynch F
        Reconstruction of the peroneal retinaculum using the peroneus quartus. A case report.
        J Bone Joint Surg Am. 1987; 69: 296-297
        • Martinelli B
        • Bernobi S
        Peroneus quartus muscle and ankle pain.
        Foot Ankle Surg. 2002; 8: 223-225
        • Chepuri NB
        • Jacobson JA
        • Fessell DP
        • Hayes CW
        Sonographic appearance of the peroneus quartus muscle: correlation with MR imaging appearance in seven patients.
        Radiology. 2001; 218: 415-419
        • Lohrer H
        • Nauck T
        • Lohrer L
        Endoscopic-assisted release of lower leg chronic exertional compartment syndromes: results of a systematic literature review.
        Sports Med Arthrosc Rev. 2016; 24: 19-23
        • Pedowitz RA
        • Hargens AR
        • Mubarak SJ
        • Gershuni DH
        Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg.
        Am J Sports Med. 1990; 18: 35-40
        • Aweid O
        • Del Buono A
        • Malliaras P
        • Iqbal H
        • Morrissey D
        • Maffulli N
        • Padhiar N
        Systematic review and recommendations for intracompartmental pressure monitoring in diagnosing chronic exertional compartment syndrome of the leg.
        Clin J Sport Med. 2012; 22: 356-370
        • Bong MR
        • Polatsch DB
        • Jazrawi LM
        • Rokito AS
        Chronic exertional compartment syndrome: diagnosis and management.
        Bull Hosp Jt Dis. 2005; 62: 77-84
        • Lotito G
        • Pruvost J
        • Collado H
        • Coudreuse J-M
        • Bensoussan L
        • Curvale G
        • Viton JM
        • Delarque A
        Peroneus quartus and functional ankle instability.
        Ann Phys Rehabil Med. 2011; 54: 282-292
        • Saupe N
        • Mengiardi B
        • Pfirrmann CW
        • Vienne P
        • Seifert B
        • Zanetti M
        Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles.
        Radiology. 2007; 242: 509-517