Skip to main content
SpringerLink
Log in

Double origin of the extensor hallucis longus muscle: a case report

  • Anatomic Variations
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Most of the anatomic variations of the extensor hallucis longus (EHL) muscle are related to the tendon of insertion. We show a double origin of the EHL from the medial aspect of the fibula and the lateral aspect of the tibia. A 27-year-old male with a double closed fracture of tibia and fibula showed an involuntary extension of the big toe during foot plantar flexion after surgery. A tendon fibrosis by the fixation plates could be the cause of the foot functional alteration. Interestingly, the anatomic variation described could be related to the postsurgical foot dysfunction, since when the fibrotic tissue was removed the normal extension of big toe recovered. As illustrated in this case report, knowledge of anatomic variations is very useful, particularly in the context of foot surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Aktekin M, Uzmansel D, Kurtoglu Z et al (2008) Examination of the accessory tendons of extensor hallucis longus muscle in fetuses. Clin Anat 21:713–717. https://doi.org/10.1002/ca.20712

    Article  PubMed  Google Scholar 

  2. Al-saggaf S (2003) Variations in the insertion of the extensor hallucis longus muscle. Folia Morphol (Warsz) 62:147–155

    Google Scholar 

  3. Bayer T, Kolodziejski N, Flueckiger G (2014) The extensor hallucis capsularis tendon-a prospective study of its occurrence and function. Foot Ankle Surg 20:192–194. https://doi.org/10.1016/j.fas.2014.04.001

    Article  CAS  PubMed  Google Scholar 

  4. Bergman RA, Afifi AK, Miyauchi R (2010) Illustrated encyclopedia of human anatomic variation: Opus I: muscular system: alphabetical listing of muscles: E. https://www.anatomyatlases.org/AnatomicVariants/MuscularSystem/Text/E/23Extensor.shtml

  5. Bibbo C, Arangio G, Patel DV (2004) The accessory extensor tendon of the first metatarsophalangeal joint. Foot Ankle Int 25:387–390. https://doi.org/10.1177/107110070402500604

    Article  PubMed  Google Scholar 

  6. Boyd N, Brock H, Meier A et al (2006) Extensor hallucis capsularis: frequency and identification on MRI. Foot Ankle Int 27:181–184. https://doi.org/10.1177/107110070602700305

    Article  PubMed  Google Scholar 

  7. Gruber W (1875) Über die varietäten des musculus extensor hallucis longus. Arch Anat Physiol Wissen Med 1875:565–589

    Google Scholar 

  8. Hill RV, Gerges L (2008) Unusual accessory tendon connecting the hallucal extensors. Anat Sci Int 83:298–300. https://doi.org/10.1111/j.1447-073X.2008.00229.x

    Article  PubMed  Google Scholar 

  9. Hallisy JE (1930) The muscular variations in the human foot: a quantitative study. Am J Anat 45:411–442. https://doi.org/10.1016/j.aanat.2017.10.006

    Article  Google Scholar 

  10. Lambert HW (2016) Leg muscles. In: bergman’s comprehensive encyclopedia of human anatomic variation. Wiley, Hoboken, pp 421–437. https://doi.org/10.1002/9781118430309

    Book  Google Scholar 

  11. Natsis K, Konstantinidis GA, Symeonidis PD et al (2017) The accessory tendon of extensor hallucis longus muscle and its correlation to hallux valgus deformity: a cadaveric study. Surg Radiol Anat 39:1343–1347. https://doi.org/10.1007/s00276-017-1881-4

    Article  CAS  PubMed  Google Scholar 

  12. Testut L, Latarjet A (1928) Traité d’anatomie humaine, vol 1. Doin, Paris, p 1149

    Google Scholar 

  13. Tezer M, Cicekcibasi AE (2012) A variation of the extensor hallucis longus muscle (accessory extensor digiti secundus muscle. Anat Sci Int 87:111–114. https://doi.org/10.1007/s12565-011-0108-8

    Article  PubMed  Google Scholar 

  14. Williams PL, Bannister LH, Berry MM et al (1995) Gray’s anatomy: the anatomical basis of medicine and surgery, 38th edn. Churchill Livingstone, Edinburgh

    Google Scholar 

  15. Zdilla MJ, Paulet JE, Lear JJ et al (2018) A review of extensor hallucis longus variants featuring a novel extensor primi internodii hallucis muscle merging with extensor hallucis brevis. J Foot Ankle Surg 57:1218–1220. https://doi.org/10.1053/j.jfas.2018.03.031

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Jose M. Egea and Laura Cabeza have the same contribution.

Authors and Affiliations

  1. Department of Anatomy and Embryology, Faculty of Medicine, University of Granada, 18071, Granada, Spain

    Jose M. Egea, Laura Cabeza, Raul Ortiz, Consolación Melguizo & José Prados

  2. Fraternidad-Muprespa, Orthpaedic Surgery Section, 18014, Granada, Spain

    Jose M. Egea

  3. Instituto de Investigación Biosanitaria ibs.GRANADA, 18012, Granada, Spain

    Laura Cabeza, Raul Ortiz, Consolación Melguizo & José Prados

  4. Institute of Biopathology and Regenerative Medicine (IBIMER), Center of Biomedical Research (CIBM), University of Granada, 18100, Granada, Spain

    Laura Cabeza, Raul Ortiz, Consolación Melguizo & José Prados

  5. Department of Health Sciences, University of Jaen, 23071, Jaen, Spain

    Ana R. Rama

Authors
  1. Jose M. Egea
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Cabeza
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raul Ortiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ana R. Rama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Consolación Melguizo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. José Prados
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Consolación Melguizo.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

276_2019_2309_MOESM1_ESM.avi

Supplementary material 1: Video 1. Testing of foot plantar flexion. Involuntary extension of the big toe during foot plantar flexion. Simultaneous plantar flexion of all toes was not possible. (AVI 2162 kb)

276_2019_2309_MOESM2_ESM.avi

Supplementary material 2: Video 2. Testing of foot plantar flexion. Following surgery (primary closure), foot plantar flexion without extension of the big toe was possible. Skin incisions and surgical staples can be observed. (AVI 518 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Egea, J.M., Cabeza, L., Ortiz, R. et al. Double origin of the extensor hallucis longus muscle: a case report. Surg Radiol Anat 41, 1421–1423 (2019). https://doi.org/10.1007/s00276-019-02309-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-019-02309-5

Keywords

Search

Navigation