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Variant Insertion of the Fibularis Tertius Muscle Is an Evidence of the Progressive Evolutionary Adaptation for the Bipedal Gait

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Variant Insertion of the Fibularis Tertius Muscle Is an Evidence of the Progressive Evolutionary Adaptation for the Bipedal Gait Clinics and Practice 2011; volume 1:e81 Variant insertion of the of the dorsal digital expansion of the fifth toe and on the dorsum of the head of the fifth Correspondence: Tara Sankar Roy, Department of fibularis tertius muscle is an metatarsal bone (Figure 1). At the mid foot Anatomy, All India Institute of Medical Sciences, evidence of the progressive region, the lateral slip formed a thick (5 mm × Ansari Nagar, New Delhi - 110029, India. evolutionary adaptation 20 mm) oblique fibrotendinous band that Tel. +91.11.265.948.80 - Fax: +91.11.265.886.63. crossed the lateral border of the foot and con - E-mail: [email protected]; [email protected] for the bipedal gait nected the FT with the flexor digiti minimi bre - vis (FDMB), a muscle residing in the third Rashmoni Jana, Tara Sankar Roy Key words: foot anomaly, musculotendinous vari - planter layer. Another notable variation was ation, fibularis tertius, anomalous leg muscle. Department of Anatomy, All India seen in the FDMB muscle, which originated Institute of Medical Sciences, New Delhi, from lateral process of the calcaneal tuberosity Acknowledgments: the authors would like to India along with abductor digiti minimi and passed thank the contribution of the first MBBS students onto the lateral surface of the fifth metatarsal (2008-09) for their excellent dissection and bone close to the tendinous insertion of the FT preparation of the specimen. muscle of the dorsum of the foot (Figure 1, Received for publication: 20 September 2011. Abstract inset). The tendon of the FDMB received the Accepted for publication: 14 October 2011. lateral head of the FT insertion at the base of Fibularis tertius (FT) is often considered as the fifth metatarsal bone. No abnormality was This work is licensed under a Creative Commons part of extensor digitorum longus (EDL) mus - noted in the innervations pattern of the anom - Attribution NonCommercial 3.0 License (CC BY- cle. The muscle is absent in hominoid apes alous muscles. No scar was found in the skin of NC 3.0). leg and foot. The anatomy of the left foot was and with the acquisition of the bipedal gait; ©Copyright R. Jana et al., 2011 unremarkable. Because these findings were the muscle emerged as a recent addition in the Licensee PAGEPress, Italy human foot. From its various modes of inser - detected during cadaveric dissection, we were Clinics and Practice 2011; 1:e81 tions, it is evident that the muscles of the sole unable to detail the case history. doi:10.4081/cp.2011.e81 are in search of its distal attachment, which can best support the relatively weak human midfoot. We describe an unusual insertion of Discussion that in 4% cases (n=110), the insertion the muscle in support of this hypothesis. extended beyond fifth metatarsal up to metatarsophalangeal joint of fifth toe, and in Classically the anatomy textbooks describe 1.5% cases, it extended up to the proximal pha - that the FT muscle inserting into the dorsal lanx of little toe. In the present study, the Introduction surface of the base of the fifth metatarsal insertion of the muscle (FT) was on the dor - bone, extending into the nearby deep fascia. 7,8,9 sum of the fifth metatarsal near its head, and Numerous studies list varying insertions of the The arch of the human foot is intrinsically a there was an aponeurotic extension of this FT muscle. Rourke et al. 6 enumerated the vari - unstable and to make the bipedal gait more tendon that progressed towards the lateral sur - effective and efficient, certain evolutionary ous modes of insertion of the FT, and in their face of the proximal phalanx of the little toe. musculoskeletal adjustments are in progress own study it was observed that the tendon was Rourke et al. 6 noted that the tendinous fibers that are reflected in many of the muscles and inserted into the dorsal surface of the shaft of fanned out and curved like a hockey stick to get bones of the foot. 1 Phylogenetically, the human both the fourth and fifth metatarsals that inserted around the fifth metatarsal. A bi- or fibularis tertius (FT) muscle is relatively extended onto the under surface of the bone. trifurcated trapezoidal insertion of the FT ten - young structure and coincides with bipedal Bryce 10 described that the tendon ended partly don into the fifth metatarsal was also locomotion. 2-6 Its various modes of insertions or wholly upon the fourth metatarsal bone. The observed. 9 The bifurcated tendon in the pres - suggested that it helps in the midfoot stability, FT may be absent up to 18% of population and which is also a recent development in the its absence neither affected the movement of ent case is another variant insertion of FT as 6 ontogeny. 3 In this case report, we describe a the midtarsal joints nor increased the inci - mentioned by Rourke et al. Although it is a unique case of variant insertions of the FT dence of either ankle or 5 th metatarsal bone weak muscle, but the contractions of the FT muscle and a lateral plantar muscle and have injury. 9,11 Also duplication of the FT tendon has may be responsible for delayed healing of the 19 discussed the possible biomechanical advan - been reported to have a 1-2% incidence in fifth metatarsal shaft fracture. Avulsion frac - tage of these insertion, in support of the afore - human. 12-15 The FT has been described as a ture or stress fracture of the fifth metatarsal said hypothesis. partially separated portion of extensor digito - bone is common but more distal insertion of rum longus (EDL). 7,16 Even intertendinous the FT tendon has little influence on healing. 19 connections have been observed between the The FT has been used with great advantage in FT and the EDL. 9 Wood-Jones 17 reported that various reconstructive and corrective surger - Case Report probably the FT has migrated from the foot in ies in the foot. 6 an upward direction and became an extrinsic The FDMB arises from the medial part of the During routine cadaveric dissection a num - muscle of the leg. The more proximal attach - plantar surface of the base of the fifth ber of variant connections and insertions of ment of the FT muscles to the tarsal bones sug - metatarsal bone, and from the sheath of fibu - the FT muscle were observed in the right foot gests a more evolved structure. 4,18 We presume laris longus. In this case study, it has taken ori - of a 64-year-old female. The FT, after originat - that due to specialized and efficient needs of gin from the lateral process of the calcaneal ing from lower part of fibula bifurcated into the human foot during walking and running, tuberosity. It has a distal tendon that inserts medial and lateral slips in the dorsum of the the FT might have lost its insertion into the into the lateral side of the base of the proximal foot. The medial slip crossed the tar - fifth digit; therefore, a strong fascial attach - phalanx of the little toe; this tendon usually sometatarsal, metatarsophalangeal and inter - ment has been developed on the dorsum of the blends laterally with the abductor digiti mini - phalangeal joints to attach to the under surface lateral border of the foot. Joshi et al. 5 found mi. Some of its deeper fibres extend to the lat - [Clinics and Practice 2011; 1:e81] [page 169 ] Case Report don may provide additional support to the arch - es of the foot. With evolution, the mid-foot became stable, and we presume that these accessory tendons may be remnant of some missing link muscles, which were present in subhuman primates. 22 The modifications of the muscle insertion acted like a truss between the segments of the arch (bowstring arch truss). Thus, it seems, the whole evolutionary process of the FT muscle is constantly evaluat - ing the truss styles for the safety of the arches of the foot. To test this hypothesis, a detailed comparative study of the muscles, bones, and soft tissue of the hominoid apes, which have detailed similarities with modern humans, is required. Figure 1. Photograph of the lateral aspect of the foot showing the structures of the dor - References sum and proximal portion of the fifth metatarsal bone (MT5). The medial slip (MH) of the bifurcated fibularis tertius tendon (FT) attached to the dorsal digital expansion of the 5th toe, and the lateral slip (LH) attached to flexor digiti mini brevis (FDMB). Fibularis 1. Harcourt-Smith WEH, Aiello LC. Fossils, brevis tendon (FB) attached to the base of the fifth metatarsal bone. EDL, Extensor dig - feet and the evolution of human bipedal itorum longus. Inset: Surgical forceps and knife handle is placed under MS and FDMB locomotion. J Anat 2004;204:403-6. close to the insertion of this tendon into the metatarsal bone. The entire course of the 2. Sokolowska-Pituchowa J, Mia kiewicz C, FDMB and the broad site of attachment of this structure to the base of the fifth ś metatarsal bone are seen. Skawina A, Mako ś K. Morphology and some measurements of the peroneus ter - tius muscle in man. Folia Morphol (Warsz) eral part of the distal half of the fifth extracellular fibrils got intermingled for these 1974;33:91-103. metatarsal bone, constituting what may be muscles that may be responsible for this kind 3. Jungers WL, Meldrum DJ, Stern JT. The described as distinct muscle, opponens digiti of anomaly. 8,20 functional and evolutionary significance minimi. These aberrant muscles are of special Electromyographic studies show that FT of the human peroneus tertius muscle.
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