Accessory soleus muscle as a cause of resistance to correction in congenital club foot: a case report

A 14-month-old female with bilateral clubfeet was initially treated by serial casting and percutaneous tenotomy of the Achilles tendon, bilaterally. Both clubfeet subsequently underwent surgical treatment with a posteromedial release through a Cincinnati incision. At surgery on one clubfoot, an accessory Soleus muscle was found anterior to the Achilles tendon with a distinct insertion on the upper surface of calcaneus, anterior and medial to the insertion of Achilles tendon. This accessory Soleus muscle may have been the cause of resistance to correction in this congenital clubfoot.     

Accessory soleus: a clinical perspective and report of three cases

Anomalies of the posterior leg musculature are not rare. Therefore, when assessing a posterior ankle mass, the possibility of an aberrant muscle must be considered. Most cases in the literature were confirmed surgically. Electromyography (EMG), nerve conduction studies, and computerized tomography (CT) may obviate surgical intervention, which should be reserved for symptomatic cases.     

Accessory soleus muscle as a cause of congenital talipes equino varus. A case report

The authors report a case of congenital clubfoot in a one-year-old male child, in which an accessory soleus muscle was noted intraoperatively, running anteromedially to the Achilles tendon and with a distinct insertion on the postero-medial aspect of the calcaneus. Correction of the varus and equinus of the hindfoot could only be achieved after cutting the tendon of the accessory soleus muscle at its insertion on the calcaneus.     

Accessory soleus muscle mimicking a soft tissue tumor. A report of 2 patients.

An accessory soleus muscle is rare, and may present as a soft tissue tumor at the ankle. We report 2 patients in whom the diagnosis was not considered until after surgical exploration. Magnetic resonance imaging (MRI) after biopsy clearly identified muscle tissue, and electromyography showed normal motor unit activity.     

一家系3代Madelung畸形4例报告

Madelung畸形是桡骨远端骨骺尺侧部分发育障碍而桡侧部分及尺骨骨骺发育正常导致的桡骨发育弯曲短缩、下尺桡关节脱位及腕部畸形,临床上较少见.     

Late recurrence of clubfoot deformity: a 45-year followup

Idiopathic clubfoot is one of the most common congenital deformities. Regardless of the mode of treatment, clubfoot has a tendency to relapse until the age of 5 years. Relapses are rare in patients after 5 years of age. A 45-year followup of a patient with idiopathic clubfoot treated as a newborn with the Ponseti method is reported. The patient had both clubfeet well-corrected as seen clinically and radiographically with this method. However, recurrent deformities developed bilaterally when the patient was 8 years old. Because of the late recurrence of this deformity, the patient had a thorough neurologic evaluation, which was normal. Treating physicians should be aware of the possibility of late recurrence in patients who have had complete correction of their clubfoot deformity.     

Accessory soleus muscle simulating a soft tissue tumor of the posteromedial ankle region.

The author reports the case of an adolescent male diagnosed with a symptomatic accessory soleus muscle. Surgical exploration with intraoperative appearance is depicted. This malady is uncommon, although it has been reported primarily as a unilateral entity.     

Accessory bone at the insertion of the levator scapulae muscle in a Sprengel deformity

A case of Sprengel deformity associated with an accessory ossicle at the insertion of the levator scapulae muscle is presented. Removal of the bone did not correct the deformity, and a Woodward procedure was necessary.     

Accessory soleus muscle. A clinical and radiographic presentation of eleven cases

When an accessory soleus muscle is present, it consists of a soft-tissue mass bulging medially between the distal part of the tibia and the Achilles tendon. It usually inserts with a separate tendon on the calcaneus anteromedial to the Achilles insertion, and may be a cause of pain on exercise. One may suspect a soft-tissue tumor, such as lipoma, hemangioma, and even sarcoma, but the anomalous muscle has a typical appearance on plain radiographs, and the appearance on computed tomography is diagnostic. If the patient is asymptomatic, no therapy is required, but if pain or other discomfort is provoked by exercise, exploration with fasciotomy or excision of the accessory muscle is recommended, as was done in six of our eleven patients who were seen between 1968 and 1985.     

Anterior tibial tendon transfer in residual dynamic clubfoot deformity

Residual forefoot adduction and supination deformities with functional problems and difficulty with shoe wear may occur during the course of management of the congenital clubfoot. Between 1975 and 1988, 55 patients with 71 feet who had residual dynamic clubfoot deformity underwent anterior tibial tendon transfer. There were 42 full anterior tibial tendon transfers (FTs) and 29 split anterior tibial tendon transfers (STs). The average age of the patient at the time of the procedure was 6 years. The age at surgery for FT was 5.3 years compared with 7.1 years in ST. The clinical appearance of the feet improved in both groups, according to Garceau's criteria. The range-of-motion improvement was noted in dorsiflexion and eversion. There was an increase of eversion strength of both groups by 1.5 grades. The radiographic improvement was noted in both forefoot adduction and supination. Although the FT group had a little better statistical data than did the ST group, the ST group had better preservation of inversion function.     

The accessory soleus muscle: a report of two cases with review of the literature

Introduction

The purpose of this study is to present two cases of accessory soleus muscle diagnosed in young athletes. The authors give diagnostic and therapeutic recommendations with a literature review.

Case reports

Two young athletes consulted us for leg pain increasing with athletic activity. Physical examination revealed a soft, non-tender mass medial to Achilles’ tendon. Lateral X-ray view of both ankles revealed an obliteration of Kager’s fat pad. Computed tomography (CT) and magnetic resonance imaging (MRI) showed muscular masses of the posterior compartment of the leg. The accessory soleus was excised from its origin to its distal insertion. The postoperative outcome was good and the previous sporty activity was regained within few months.

Discussion

The accessory soleus muscle is a rare supernumerary muscle of the leg whose clinical manifestation is exceptional. Different anatomic types have been described. Clinical presentation consists most often in a mass of the postero-medial compartment of the leg, which becomes painful during the effort. MRI is the major diagnostic tool. It not only allows diagnostic confirmation but also guides the treatment. As far as therapy is concerned, surgery is not the only alternative, but it remains the most efficient one. Conclusion: The accessory soleus is not so rare. Recognizing this anomaly using clinical findings, X-rays and MRI investigation results in proposing a management adapted to the importance of the functional discomfort. Surgery remains the most efficient treatment.     

Treatment of late recurring idiopathic clubfoot deformity in adults

Late recurrence of idiopathic clubfoot deformity in adults after prior successful surgery in childhood remains a rarity and only case reports exist. No study has yet clarified the results of triple arthrodesis in such cases. Complete clinical and radiological review of 7 patients (7 feet) after a follow-up time of 43 months following triple arthrodesis was undertaken. The time interval between the last surgical intervention and the triple arthrodesis averaged 27 years. The American Orthopaedic Foot and Ankle Society (AOFAS) score was used as an outcome measure. Average age at time of review was 36 years (range 18-45). All patients were examined clinically and radiologically. The AOFAS-score improved from 43 points preoperatively to 61 points at follow-up (p = 0.004). If adjusted by excluding subtalar motion, the relative score improved by 19% (from 46% to 65%; p = 0.0043). Although not significantly altered (p = 0.1), pain scores remained fair (25 points) but were improved compared with the preoperative evaluation (13 points). Ankle motion was not changed. Although statistically not significant, there was an increase in degree of ankle arthritis in 67% of patients (one patient had ankle fusion) and mid- and forefoot degenerative changes in 57%. Hindfoot alignment remained fair after surgical intervention. Triple arthrodesis is a palliative means to correct recurrent deformity in patients with idiopathic clubfoot. Despite residual symptoms and degenerative changes at the ankle, 86% of all patients were satisfied with the postoperative result.     

Treatment of residual adduction deformity in clubfoot: the double osteotomy.

Forefoot adduction is the most common residual deformity after clubfoot surgery. Surgical treatment of this deformity is often required for moderate and severe cases. This study reports the results of a closing wedge osteotomy of the cuboid and opening wedge osteotomy of the medial cuneiform in 39 feet. The average follow-up was 4.8 years. Clinical and radiographic improvement was seen in all patients, and no complications were seen. Surgery is advocated in children older than age 4, or when the medial cuneiform ossific nucleus is well developed.     

Role of talocalcaneal osteotomy in clubfoot surgery: results in 31 surgically treated feet

The most important deformities in clubfeet can be demonstrated by simultaneous arthrography of the talonavicular and talocrural joints. In patients with a severe talar deformity, wedge osteotomy through the talar neck and calcaneus has been performed as a prerequisite for correction. Our series consisted of 20 patients with 31 idiopathic clubfeet with pronounced talar deformity. The mean observation time after osteotomy was 11 years 3 months. The principles and aims are described, as are the indications for talocalcaneal osteotomy. Results were good in 19 feet (60%), fair in six (20%), and poor in six (20%).