Bilateral aplasia of the tibialis anterior and unilateral aplasia of the extensor hallucis longus muscles

Bilateral aplasia of the extensor hallucis longus muscles

A 1year and 10 months old girl was referred by the general practitioner because of abnormal position of both big toes. Her mother had the same complaint, but only on the left foot. Clinical examination of the girl showed bilateral absence of the extensor hallucis longus tendons, while in the mother, the same anomaly was found only on the left side. Ultrasound confirmed the absence of both tendons and showed an aplasia of both muscle bellies in the girl: findings not previously reported in the literature.

Compensating for loss: running on one tibialis anterior

Rupture of the tibialis anterior (TA) tendon is rare and may be either traumatic or spontaneous. TA is the main ankle dorsiflexor, providing 80% of the power, as well as contributing to inversion of the foot. We describe a case of an 84-year-old male who was incidentally diagnosed with absence of his left TA at age 46 while preparing for his first-ever marathon. There was no history of specific injury to this tendon. He subsequently went on to lead an active sporting life, completing over 20 marathons with a best time of 3 hours 12 min.

Diagnosis and management of symptomatic muscle herniation of the extremities: a retrospective review

BACKGROUND

There is a paucity of published literature on diagnosis and surgical management of muscle herniation of the extremities, with most reported cases involving military personnel and men aged 18 to 40 years. Hypothesis/

PURPOSE

The purpose of this study is to describe the presentation, diagnosis, and results of fasciotomy for symptomatic muscle herniation in young athletes. We hypothesize that fasciotomy can be a safe and effective treatment option that allows the majority of athletes to return to sports.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

From 2001 to 2011, 26 athletes (19 women; 11 runners) with a mean age 19.0 ± 4.0 years (range, 14.2-28.4 years) underwent fasciotomy for symptomatic muscle herniation at the authors' institution. Retrospective chart review recorded pertinent patient data and clinical course. Questionnaires were sent to all patients to assess satisfaction with surgery, ability to return to sports, and residual symptoms.

RESULTS

Muscle hernias were classified as primary (n = 8, 31%), postsurgical (n = 8, 31%), and associated with underlying untreated chronic exertional compartment syndrome (n = 10, 38%). The tibialis anterior muscle (n = 12, 46%) was most commonly involved. The mean time from onset of symptoms to surgery was 15.1 ± 8.6 months (range, 3-38 months). Dynamic ultrasound (5/6 patients, 83%) was more accurate than magnetic resonance imaging (3/18, 17%) at identifying the hernia. At median follow-up of 28 months (range, 12-127 months), 17 patients (65%) had returned to sports. Seventeen patients (65%) completed the postoperative questionnaire; 14 reported being satisfied with their results (82%). Mild residual symptoms were common (9 of 17 respondents, 53%), especially in runners (5 of 7, 71%), all of whom were satisfied with surgery. Patients with a postsurgical muscle herniation took the longest to return to sports and were the least likely to return to sports, had the highest rate of dissatisfaction with surgery, and were most likely to have persistent symptoms not improved by surgery.

CONCLUSION

Fasciotomy is a safe surgical option for symptomatic muscle herniation in young athletes. Many patients are able to return to sports and most are satisfied with surgery. Residual symptoms are common, especially in runners. Patients with postsurgical muscle herniations may have the worst clinical outcome.

Bilateral congenital absence of the anterior tibialis tendon: case report

Level of Evidence: V, Expert Opinion