open access

Vol 82, No 2 (2023)
Case report
Submitted: 2021-10-28
Accepted: 2021-11-30
Published online: 2022-02-17
Get Citation

Case report of the double-headed extensor hallucis longus

K. Ruzik1, K. Westrych1, R. S. Tubbs2345, Ł. Olewnik1, P. Łabętowicz6, N. Zielinska1
·
Pubmed: 35187631
·
Folia Morphol 2023;82(2):429-433.
Affiliations
  1. Department of Anatomical Dissection and Donation, Medical University of Lodz, Poland
  2. Department of Neurosurgery, Tulane University School of Medicine, New Orleans, LA, United States
  3. Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, United States
  4. Department of Anatomical Sciences, St. George’s University, Grenada, West Indies
  5. Department of Surgery,Tulane University School of Medicine, New Orleans, LA, United States
  6. Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland

open access

Vol 82, No 2 (2023)
CASE REPORTS
Submitted: 2021-10-28
Accepted: 2021-11-30
Published online: 2022-02-17

Abstract

Background: We present a case report of double-headed extensor hallucis longus
(EHL) with potential clinical significance.
Materials and methods: Cadaveric dissection of the right lower limb of a 70-year-
-old at death female was performed for research and teaching purposes at the
Department of Anatomical Dissection and Donation, Medical University of Lodz.
The limb was dissected using standard techniques according to a strictly specified
protocol. Each head and tendon of the muscle was photographed and subjected
to further measurements.
Results: During dissection, an unusual type of EHL muscle was observed. It
consisted of two muscle bellies, a main tendon and an accessory tendon. Both
muscle bellies were located on anterior surface of the fibula and the interosseous
membrane. The main tendon insertion was located on the dorsal aspect of the
base of the distal phalanx of the big toe, while the accessory tendon insertion
was located medially.
Conclusions: The EHL muscle is highly morphologically variable at both the point
of origin and the insertion. Knowledge of its variations is connected to several
pathologies such as foot drop, tendonitis, tendon rupture, and anterior compartment
syndrome.

Abstract

Background: We present a case report of double-headed extensor hallucis longus
(EHL) with potential clinical significance.
Materials and methods: Cadaveric dissection of the right lower limb of a 70-year-
-old at death female was performed for research and teaching purposes at the
Department of Anatomical Dissection and Donation, Medical University of Lodz.
The limb was dissected using standard techniques according to a strictly specified
protocol. Each head and tendon of the muscle was photographed and subjected
to further measurements.
Results: During dissection, an unusual type of EHL muscle was observed. It
consisted of two muscle bellies, a main tendon and an accessory tendon. Both
muscle bellies were located on anterior surface of the fibula and the interosseous
membrane. The main tendon insertion was located on the dorsal aspect of the
base of the distal phalanx of the big toe, while the accessory tendon insertion
was located medially.
Conclusions: The EHL muscle is highly morphologically variable at both the point
of origin and the insertion. Knowledge of its variations is connected to several
pathologies such as foot drop, tendonitis, tendon rupture, and anterior compartment
syndrome.

Get Citation

Keywords

extensor hallucis longus, additional muscle belly, anatomical variations, hallux valgus, embryology

About this article
Title

Case report of the double-headed extensor hallucis longus

Journal

Folia Morphologica

Issue

Vol 82, No 2 (2023)

Article type

Case report

Pages

429-433

Published online

2022-02-17

Page views

2321

Article views/downloads

775

DOI

10.5603/FM.a2022.0018

Pubmed

35187631

Bibliographic record

Folia Morphol 2023;82(2):429-433.

Keywords

extensor hallucis longus
additional muscle belly
anatomical variations
hallux valgus
embryology

Authors

K. Ruzik
K. Westrych
R. S. Tubbs
Ł. Olewnik
P. Łabętowicz
N. Zielinska

References (38)
  1. Al-Saggaf S. Variations in the insertion of the extensor hallucis longus muscle. Folia Morphol. 2003; 62(2): 147–155.
  2. Aragonés P, Rodríguez-Niedenführ M, Quinones S, et al. Popliteal artery: Anatomical study and review of the literature. Ann Anat. 2021; 234: 151654.
  3. Bardeen C. Studies of the development of the human skeleton. (A). The development of the lumbab, sacbal and coccygeal vertebwe. (B). The cubves and the pbopobtionate regional lengths of the spinal column during the first thbee months of embbyonic developnent. (C). The development of the skeleton of the posterior limb. Am J Anat. 1905; 4(3): 265–302.
  4. Bardeen C. Development and variation of the nerves and the musculature of the inferior extremity and of the neighboring regions of the trunk in man. Am J Anat. 1906; 6(1): 259–390.
  5. Barham G, Clarke NMP. Genetic regulation of embryological limb development with relation to congenital limb deformity in humans. J Child Orthop. 2008; 2(1): 1–9.
  6. Beddard F. VII. Contributions to the anatomy of the anthropoid apes. Trans Zool Soc Lndon. 1893; 13(5): 177–218.
  7. Bibbo C, Arangio G, Patel DV. The accessory extensor tendon of the first metatarsophalangeal joint. Foot Ankle Int. 2004; 25(6): 387–390.
  8. Boyer E. The musculature of the inferior extremity of the orang-utan Simia satyrus. Am J Anat. 1935; 56(2): 193–256.
  9. Denk CC, Oznur A, Sürücü HS. Double tendons at the distal attachment of the extensor hallucis longus muscle. Surg Radiol Anat. 2002; 24(1): 50–52.
  10. Egea JM, Cabeza L, Ortiz R, et al. Double origin of the extensor hallucis longus muscle: a case report. Surg Radiol Anat. 2019; 41(12): 1421–1423.
  11. Fadel GE, Alipour F. Rupture of the extensor hallucis longus tendon caused by talar neck osteophyte. Foot Ankle Surg. 2008; 14(2): 100–102.
  12. Ferrero EM, Pastor F, Fernandez F, Barbosa M, Diogo R, Wood B. Comparative anatomy of the lower limb muscles of hominoids: attachments, relative weights, innervation and functional morphology. In: Everett F, Hughes and Medison E. Hill (ed.) PRIMATES: Classification, Evolution and Behavior. Nova publishers 2012.
  13. Gros J, Tabin CJ. Vertebrate limb bud formation is initiated by localized epithelial-to-mesenchymal transition. Science. 2014; 343(6176): 1253–1256.
  14. Iwanaga J, Singh V, Takeda S, et al. Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors. Clin Anat. 2021; 34(1): 2–4.
  15. Je SS, Park B, Kim J, et al. Five-headed biceps brachii muscle with a rare origin from the tendon of pectoralis major muscle. Anat Sci Int. 2016; 91(1): 110–113.
  16. Johnson KA, Spiegl PV. Extensor hallucis longus transfer for hallux varus deformity. J Bone Joint Surg Am. 1984; 66(5): 681–686.
  17. Karauda P, Shane Tubbs R, Polguj M, et al. Morphological variability of the extensor hallucis longus in human fetuses. Ann Anat. 2021; 234: 151627.
  18. Lewis OJ. The phylogeny of the cruropedal extensor musculature, with special reference to the primates. J Anat. 1966; 100(PT 4): 865–880.
  19. Lezak B, Summers S. Anatomy, Bony Pelvis and Lower Limb, Extensor Hallucis Longus Muscle. . StatPearls Publishing, Treasure Island (FL) 2021.
  20. Lezak B B, Wehrle CJ, Summers S. Anatomy, Bony Pelvis and Lower Limb, Posterior Tibial Artery. StatPearls Publishing, Treasure Island (FL) 2020.
  21. Mróz I, Kielczewski S, Pawlicki D, et al. Blood vessels of the shin - anterior tibial artery - anatomy and embryology - own studies and review of the literature. Folia Med Cracov. 2016; 56(1): 33–47.
  22. Natsis K, Konstantinidis GA, Symeonidis PD, et al. The accessory tendon of extensor hallucis longus muscle and its correlation to hallux valgus deformity: a cadaveric study. Surg Radiol Anat. 2017; 39(12): 1343–1347.
  23. Ng JM, Rosenberg ZS, Bencardino JT, et al. US and MR imaging of the extensor compartment of the ankle. Radiographics. 2013; 33(7): 2047–2064.
  24. Olewnik Ł. Fibularis tertius: anatomical study and review of the literature. Clin Anat. 2019; 32(8): 1082–1093.
  25. Olewnik Ł, Paulsen F, Tubbs RS, et al. Potential compression of the musculocutaneous, median and ulnar nerves by a very rare variant of the coracobrachialis longus muscle. Folia Morphol. 2021; 80(3): 707–713.
  26. Olewnik Ł, Podgórski M, Polguj M, et al. Is ultrasound effective in determining variation of the insertion of the extensor hallucis longus tendon? Clin Anat. 2020; 33(8): 1235–1239.
  27. Olewnik Ł, Podgórski M, Polguj M, et al. A cadaveric study of the morphology of the extensor hallucis longus - a proposal for a new classification. BMC Musculoskelet Disord. 2019; 20(1): 310.
  28. Olewnik Ł, Tubbs RS, Ruzik K, et al. Quadriceps or multiceps femoris? Cadaveric study. Clin Anat. 2021; 34(1): 71–81.
  29. Olewnik Ł, Zielinska N, Karauda P, et al. A three-headed plantaris muscle: evidence that the plantaris is not a vestigial muscle? Surg Radiol Anat. 2020; 42(10): 1189–1193.
  30. Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg Am. 2011; 93(17): 1650–1661.
  31. Roukis TS. Flexor hallucis longus and extensor digitorum longus tendon transfers for balancing the foot following transmetatarsal amputation. J Foot Ankle Surg. 2009; 48(3): 398–401.
  32. Ruzik K, Waśniewska A, Olewnik Ł, et al. Unusual case report of seven-headed quadriceps femoris muscle. Surg Radiol Anat. 2020; 42(10): 1225–1229.
  33. Via AG, Oliva F, Spoliti M, et al. Acute compartment syndrome. Muscles Ligaments Tendons J. 2015; 5(1): 18–22.
  34. Vittoria N, Giuseppe M, Ivano D, et al. The innervation of extensor hallucis longus muscle: an anatomical study for selective neurotomy. Acta Neurochir (Wien). 2009; 151(10): 1275–1279.
  35. Zdilla MJ, Paulet JE, Lear JJ, et al. A review of extensor hallucis longus variants featuring a novel extensor primi internodii hallucis muscle merging with extensor hallucis brevis. J Foot Ankle Surg. 2018; 57(6): 1218–1220.
  36. Zielinska N, Olewnik Ł. Six-headed coracobrachialis muscle. Folia Morphol. 2022; 81(3): 809–813.
  37. Zielinska N, Olewnik Ł, Karauda P, et al. A very rare case of an accessory subscapularis muscle and its potential clinical significance. Surg Radiol Anat. 2021; 43(1): 19–25.
  38. Zielinska N, Tubbs RS, Ruzik K, et al. Classifications of the extensor hallucis longus tendon variations: Updated and comprehensive narrative review. Ann Anat. 2021; 238: 151762.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., Grupa Via Medica, Świętokrzyska 73, 80–180 Gdańsk, Poland

tel.: +48 58 320 94 94, faks: +48 58 320 94 60, e-mail: viamedica@viamedica.pl