- Visibility 303 Views
- Downloads 273 Downloads
- Permissions
- DOI 10.18231/j.ijashnb.v.11.i.2.4
-
CrossMark
Absence of the fourth tendon of flexor digitorum brevis in the right foot of a male cadaver: A case report with clinical implications
- Author Details:
-
Sancy Charly
-
Rajasekhar S.S.S.N *
Sancy Charly
Rajasekhar S.S.S.N *
The Flexor digitorum brevis (FDB) muscle of the plantar aspect of the foot typically forms four tendons that insert into the lateral four toes. Although variations in tendon number and insertion patterns are common (13-83% worldwide), they are critically understudied with respect to biomechanical implications, especially in populations with high prevalence for variation (77.3% in South Asians). The present case report describes the unilateral absence of the fourth FDB tendon of a 60-year-old male cadaver of South Asian origin using comprehensive morphometric analysis using digital callipers: muscle belly length measured 82.20 mm and widths varied (proximal: 9.10 mm, midpoint: 11.4 mm, distal: 5.92 mm); the remaining three tendons measured 79.09 mm, 65.24 mm, and 56.77 mm. This quantitative documentation adds to limited morphometric data available for South Asian populations and provides population-specific reference values crucial to surgical planning as well as demonstrating a need for biomechanical analysis and standardized clinical assessment protocols in high-variation populations.
References
- Bernhard A, Miller J, Keeler J, Siesel K, Bridges E. Absence of the fourth tendon of the flexor digitorum brevis muscle: a cadaveric study. Foot Ankle Spec. 2013;6(4):286–9.
- Quiñones-Rodriguez JI, Mantilla-Rosa C, Rodríguez F, Villamil CI, Fernández J, González-Solá M, et al. A missing flexor digitorum brevis tendon and its relationship to sex and ancestry: evaluation in Hispanic population. Anatomia. 2022;1(2):210–6.
- Agarwal R, Khajuria S, Saini H. Study of absence of 4th tendon of flexor digitorum brevis muscle. Int J Anat Res. 2017;5(3.2):4247–50.
- Roberts TJ, Konow N. How tendons buffer energy dissipation by muscle. Exerc Sport Sci Rev. 2013;41(4):186–93.
- Kelly LA, Cresswell AG, Racinais S, Whiteley R, Lichtwark G. Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch. J R Soc Interface. 2014;11(93):20131188.
- Tarpey MD, Amorese AJ, Balestrieri NP, Ryan TE, Schmidt CA, McClung JM, et al. Characterization and utilization of the flexor digitorum brevis for assessing skeletal muscle function. Skelet Muscle. 2018;8(1):14.
- Ilayperuma I. On the variations of the muscle flexor digitorum brevis: anatomical insight. Int J Morphol. 2012;30(1):337–40.
- Yammine K. The fourth slip of the flexor digitorum brevis muscle of the human foot. A systematic review and meta- analysis. Ital J Anat Embryol. 2015;120(1):59–70.
- Lobo SW, Menezes RG, Mamata S, Baral P, Hunnargi SA, Kanchan T, et al. Phylogenetic variation in flexor digitorum brevis: a Nepalese cadaveric study. Nepal Med Coll J. 2008;10(4):230–2.
- Wood Jones F. Structure and function as seen in the foot. 2nd ed. London: Baillière, Tindall and Cox; 1949.
- Pośnik M, Zielinska N, Gonera B, Olewnik Ł, Głowacka M, Maślanka K, et al. A literature review of the morphological variability in the intrinsic muscles of the foot: traps awaiting clinicians during ultrasound. J Clin Med. 2024;13(15):4286.
- McKeon PO, Fourchet F. Integrating the foot and ankle complex in dynamic postural control paradigms. J Athl Train. 2023;58(2):89–97.
- Chang R, Kent-Braun JA, Hamill J. Use of MRI for volume estimation of tibialis posterior and plantar intrinsic foot muscles in healthy and chronic plantar fasciitis limbs. Clin Biomech. 2012;27(5):500–5.
- Mickle KJ, Nester CJ. Morphology of the toe flexor muscles in older adults with toe deformities. Arthritis Care Res (Hoboken). 2018;70(6):902–7.
- Nakale NT, Strydom A, Saragas NP, Ferrao PNV. Association between plantar fasciitis and isolated gastrocnemius tightness. Foot Ankle Int. 2018;39(3):271–7.
- Albanese GAM, Marchi T, Cani V, Mazzoni C, Brun F, Palermo E. Advanced ankle and foot sonoanatomy: imaging beyond the basics. Diagnostics. 2020;10(3):160.
- Arquez H. An anatomical study of the musculus flexor digitorum brevis. Int Arch Med. 2017;10:1–8.
- Bojja S, Borra V, Bhingardeo A, Chandrupatla M, Amlan A, Ansari A. Anatomical variations of flexor muscles in sole. J Neurol Res Rev Rep. 2023;5(2):1–4.
- Farris DJ, Kelly LA, Cresswell AG, Lichtwark GA. The functional importance of human foot muscles for bipedal locomotion. Proc Natl Acad Sci USA. 2019;116(5):1645–50.
- Ridge ST, Olsen MT, Bruening DA, Jurgensmeier K, Griffin D, Davis IS, et al. Walking in minimalist shoes is effective for strengthening foot muscles. Med Sci Sports Exerc. 2019;51(1):104–13.
- Fernández-Gibello A, Moroni S, Camuñas G, Montes R, Zwierzina M, Tasch C, et al. Ultrasound-guided decompression surgery of the tarsal tunnel: a novel technique for the proximal tarsal tunnel syndrome. Surg Radiol Anat. 2019;41(6):615–24.
- Myerson MS, Kadakia AR. Reconstructive foot and ankle surgery: management of complications. 3rd ed. Philadelphia: Elsevier; 2018. Charly and Rajasekhar S.S.S.N / IP Indian Journal of Anatomy and Surgery of Head, Neck and Brain 2025;11(2):45–49 49
- Beğer O, Elvan Ö, Keskinbora M, Ünal B, Uzmansel D, Kurtoğlu Z. Anatomy of master knot of Henry: a morphometric study on cadavers. Acta Orthop Traumatol Turc. 2018;52(2):134–42.
- Narici M, Franchi M, Maganaris C. Muscle structural assembly and functional consequences. J Exp Biol. 2016;219(2):276–84.
- Iwanaga J, Singh V, Ohtsuka A, Hwang Y, Kim H-J, Moryś J, et al. Acknowledging the use of human cadaveric tissues in research papers: recommendations from anatomical journal editors. Clin Anat. 2021;34(1):2–4.