0:00

Let's now look at the final group,

0:03

which is the lateral tendons.

0:04

And here we deal with the peroneous brevis tendon shown

0:08

here, the peroneus longest, uh, muscle

0:12

and tendon shown here in the peroneus Perus.

0:16

These are responsible for aversion of the ankle

0:19

and Hein foot.

0:22

Let's talk a bit about the anatomy of these, uh,

0:24

important tendons.

0:26

I'm showing you here a sagittal section

0:28

through the lateral aspect of the ankle at the level

0:32

of the distal fibula showing you course

0:36

of the peroneous longest located

0:38

behind the peroneous brevis.

0:40

The peroneous brevis continues to attach

0:43

to the dorsal aspect of the fifth metatarsal bone.

0:47

The peroneous longest is gonna swing medially out

0:50

of the point, uh, out

0:52

of view on this single sagittal section.

0:55

Let's look at the netter drawing for more information.

0:59

Here we can see the brevis

1:00

and longest classically entering a common tendon sheath

1:05

above the level of the ankle.

1:07

That common tendon sheath

1:11

will pass more distally along with the two tendons beneath

1:16

the superior and inferior perineal ret macular.

1:20

Somewhere during its course it will divide into two separate

1:24

sheets, one about the peroneous brevis tendon shown

1:29

here, the other about the peroneous longest tendon.

1:33

Now I can tell you there are variations in the extent

1:37

of these synovial sheets,

1:39

and I've seen cases

1:41

with teno synovial fluid about the peroneous longest tendon

1:45

all the way along the plantar aspect of the foot.

1:49

So this is just a rough idea of what the anatomy looks like.

1:55

I might tell you, and I'll show you in subsequent slides,

1:58

that these tendons are intimate with one

2:01

of the ligaments we're gonna talk about later, uh uh today.

2:06

And that is the calcan fibrile ligament.

2:09

As the peroneous longest tendon descends,

2:13

it makes three turns

2:15

and wherever it turns, it is a bit vulnerable

2:18

to tendon pathology.

2:20

The first of these we'll call the retromolar turn at the

2:24

region of the superior perineal ret macular.

2:27

The second of these occurs at the trochlear process

2:31

or tubercle of the calcaneus in the region

2:34

of the inferior reac.

2:37

And the third, which is the most acute turn,

2:40

and you can see it here occurs, occurs in the area

2:44

of the Q Boy groove or tunnel as it is curve.

2:48

This is a very vulnerable site for problems

2:52

with the peroneous longest tendon.

2:54

And I'll show you one example a bit later.

2:58

As we all know, there is an OS perineum

3:01

that is located within the peroneous longest tendon,

3:05

often bilateral and ossified.

3:07

But here is another example

3:10

of a fibro cartilaginous nodule within

3:14

that particular tendon that can simulate pathology

3:19

so much as we talked about

3:21

when we discuss the tibials posterior tendon.

3:24

Here we deal with the peroneus longest tendon

3:30

in the coronal plane.

3:31

You can see the peroneus brevis tendon located

3:34

above the peroneus longest tendon.

3:38

This is a more posterior section

3:40

here in the same plane anteriorally.

3:43

Here's the perineal tubercle,

3:46

and at that level, the brevis tendon is located above

3:49

and the longest tendon is located below.

3:52

You can imagine, and I think I'll show you this later,

3:55

that if this is enlarged, it may create problems for one

3:59

or both of those peroneal tendons

4:02

in the transverse plane at the level of the ankle joint.

4:07

You can see the peroneous brevis tendon typically located

4:12

anterial medial to the peroneous longest tendon.

4:15

Here is the peroneous brevis muscle.

4:19

Here's what it would look like in an Mr image.

4:23

Here is the peroneous brevis.

4:25

Note that it can appear flattened behind it the longest.

4:29

And here is the peroneous brevis muscle.

4:32

So the general rule that we have is that typically

4:38

the peroneous brevis tendon is antal medial

4:42

or medial, okay?

4:45

That is, uh, typical of

4:47

what we see when we in fact are relating it

4:50

to the peroneous longest tendon.

4:53

So antral medial

4:54

or medial, as shown in two cadavers

4:58

where we've done axial sections.

5:00

Now, there are a number of abnormalities that will lead

5:03

to displacement of the perineals.

5:05

One of these not well known is something called portion

5:10

of the perineal tendons within their sheet.

5:13

And you can see this sort of torsion even without tearing

5:17

of either perineal tendon.

5:19

So what is occurring here is an abnormal position

5:23

where the perineal brevis tendon is located above

5:27

and lateral, and then alongside

5:31

the peroneous longest tendon.

5:33

This is abnormal portion of the perineal tendons.

5:38

One further view of these tendons where these are transverse

5:43

sections and images at the level of the calcaneus,

5:46

showing you the perineal tubercle in front of it,

5:50

the peroneus brevis tendon behind it,

5:53

the peroneus longest tendon. I want

5:56

To call your attention that there are two bumps at this

5:59

level, not just the tubercle,

6:01

but a second bump that is known as the retro

6:05

trochlear eminence.

6:07

I always remind myself,

6:09

and you look at the surface of the calcaneus, these are two

6:13

of three bumps that you will see.

6:16

The third bump, I'll show you later, it relates

6:18

to the attachment site of the calcan fibular ligament.

6:24

Here is an enlarged

6:26

or prominent perineal tubercle, which is emus.

6:30

As you can see. It can lead

6:33

to problems in this case tendinosis

6:36

and at least partial tearing

6:38

of the perineal longest tendon shown here.

6:47

A number of anatomic variations are seen

6:50

with these perineal tendons.

6:52

And in addition, there is an accessory muscle

6:54

that is very frequently seen, known

6:57

as the peroneous corus muscle.

7:00

I show the classic location here,

7:03

and the usual occur is it attaches to the calcaneus

7:07

as shown these, uh, picture taken from the literature,

7:11

but it has other attachments sites as well.

7:15

Okay? It can attach to the peroneous brevis tendon

7:19

or even to the fifth metatarsal.