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International Journal of Morphology

On-line version ISSN 0717-9502

Int. J. Morphol. vol.25 no.4 Temuco Dec. 2007

http://dx.doi.org/10.4067/S0717-95022007000400032 

 

Int. J. Morphol, 25(4):881-884,2007.

Case Report

 

The Accessory Soleus Muscle: Case Report and a Review of the Literature

El Músculo Soleo Acesorio: Reporte de Caso y Revisión de la Literatura

 

*Francisco Prado Reis; **José Aderval Aragão; ***Atson Carlos de Souza Fernandes; ****Vera Lucia Corrêa Feitosa; **Ricardo Fakhouri & *Marco Antonio Prado Nunes

* Universidade Tiradentes (UNIT), Brasil.
** Universidade Federal de Sergipe (UFS) e Universidade Tiradentes (UNIT), Brasil.
*** Universidade Estadual da Bahia (UNEB), Brasil.
**** Universidade Federal de Sergipe (UFS), Brasil.

Dirección para correspondencia


RESUMEN: Durante una disección de rutina, se encontró un músculo soleo accesorio, en la pierna izquierda de un cadáver masculino. El músculo se localizaba posteromedialmente en la pierna, entre los músculos flexor largo de los dedos y largo del hálux. Su origen estaba en el tercio superior de la fascia anterior del músculo soleo y su inserción se realizaba, a través de un tendón en la superficie anteromedial del hueso calcáneo.

PALABRAS CLAVE: Músculo; Músculo soleo accesorio; Variación anatómica.

SUMMARY: An accessory soleus muscle was found in the left leg of a male cadaver in the dissecting room. The muscle was situaded posteromedially, between the soleus muscle and the flexor digitorum longus and flexor hallucis longus. The origin of the muscle was in the superior third of the anterior fascia of the soleus muscle and the insertion, was attached with separate tendon, in the anteromedial surface of calcaneus bone.

KEY WORDS: Muscle; Accessory soleus muscle; Anatomical variation.


INTRODUCTION

The occurrence of an accessory soleus muscle seems to be the most frequent anatomical description among the variations in the calf muscles (Motto & Hollo way, 1996). The first description of this variation is sometimes attributed to Craveilhier (Testut, 1884; Brodie et al., 1997) and sometimes to Turner, (Boisgard et al., 1996).

Initially, the accessory soleus muscle was considered to be a supernumerary muscle or an anatomical variation of the plantar muscle. According to Petterson et al. (1987), the incidence of the accessory soleus muscle ranges from 0.7 to 5.5%. Recently, Kouvalchouk et al. (2005) estimated that it was present in 10% of all individuals. Some authors, like Christodoulou et al. (2004) and Kendi et al. (2004), considered that the occurrence of an accessory soleus muscle was a rare anatomical variation. John & Borrelli (1999) stated that the accessory soleus muscle is infrequently observed and reported, clinically. According to Palaniappan et al. (1999), it was a chance finding that could be confounded with a soft-tissue tumor. Dunn (1965) was the first to demonstrate that the accessory soleus muscle was involved in painful syndromes of the lower limbs. These syndromes may occur in the calf (Garg & Kilcoyne, 1997), ankle (Vanek & Fourré, 1993) and leg (Pla et al, 1996).

Downey et al. (1996) conducted a review of the literature, taking into consideration a 30-year period starting in 1965, and reported the occurrence of 70 cases. According to Boisgard et al., between 1869 and 1995, there were reports of 100 symptomatic cases. The English-language literature has been the principal source of anatomical and clinical records regarding the accessory soleus muscle (Lorentzon & Wirrell, 1987; Chittaranjan et al, 1994; Sekiya et al, 1994; Pla et al.; Garg & Kilcoyne; Palaniappan et al.; John & Borrelli; Kendi et al.; Christodoulo et al.; Kouvalchouk et al).

The medical literature demonstrates that the occurrence of the accessory soleus muscle is an important anatomical and clinical finding. In our environment, this type of finding may be rare or may not have received due attention yet, and for this reason we decided to put our present finding on the record.

CASE REPORT. In the dissection room of the Anatomy Laboratory of the Bahia School of Medicine, an accessory soleus muscle was found in the left lower limb of the cadaver of an unidentified dark-skinned male individual, with an apparent age of between 40 and 45 years. It was a thick, flat, elliptically shaped muscle mass that was located posteromedially in the lower leg, between the soleus muscle and, anteriorly, the flexor giditorum longus muscle and the flexor hallucis longus muscle (Fig. 1). The origin was into the upper third of the anterior fascia of the soleus muscle (Fig. 2). The insertion of the acessory soleus muscle was into the anteromedial surface of the calcaneus bone, by means of their own tendon (Fig. 3).


DISCUSSION

An accessory soleus muscle with well-defined anatomical characteristics regarding location, shape, volume and course was found. These anatomical characteristics are reminiscent of the descriptions by Faller (1942) and Sekiya et al.. The proximal and distal insertions of the muscle coincided with what had been described by most authors.

Dunn highlighted the clinical significance of the accessory soleus muscle and, subsequent to that work, the anatomical and orthopedic literature became enriched with several other clinical records of its occurrence (Gordon & Matheson, 1973; Ayala et al, 1982; Percy & Telep, 1984; Romanus et al, 1986; Petterson et al.; Lorentzon & Wirell; Vanek & Fourré; Motto & Holloway; Pla et al.; Garg & Kilcoyne; Palaniappan et al.; Chotigavanichaya et al., 2000; Dos Remedios & Jolly, 2000; Kendi et al.; Kouvalchouk et al).

Even though descriptions of the accessory soleus muscle are infrequent in anatomy textbooks, Kouvalchouk et al., recently accepted that it might be a finding in 10% of all individuals and that this would frequently be asymptomatic. Downey estimated that 2% of the cases could be asymptomatic. Thus, the frequent reviews of the literature seem to justify the reporting of cases of accessory soleus muscle. These reviews have suggested that clinicians and surgeons should include the presence of this muscle in the differential diagnosis for soft-tissue intumescence on the posteromedial face of the ankle region (Ger & Sedlin, 1976; del Sol et al., 1989; Travis & Pitcher, 1995; John & Borrelli; Dos Remedios & Joly; Kendi et al.).

 

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Correspondencia para:

Dr. Francisco Prado Reis
Rua Silvio César Leite, 301, Apt 1203
Bairro Salgado Filho
CEP 49020-060
Aracaju, Sergipe

BRASIL

E-mail: pradoreis@sergipenet.com.br

Received: 16-10-2006 Accepted: 17-07-2007

 

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