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The peroneal muscles, also known as the fibular muscles or peroneus muscles, are a group of muscles in the lateral compartment of the lower leg. The muscle group is composed of three muscles: the peroneus longus, peroneus brevis, and peroneus tertius. The peroneus longus and peroneus brevis make up the lateral compartment of the leg, while the peroneus tertius is located in the anterior compartment. The peroneal muscles are highly variable, with several variants occasionally present, including the peroneus digiti minimi and the peroneus quartus. The peroneal tendons are extensions of the peroneus longus and peroneus brevis muscles and are held in place by the superior peroneal retinaculum.
| Characteristics | Values |
|---|---|
| Other Names | Fibularis muscles, Peroneus muscles |
| Number of Muscles | 3 |
| Muscle Names | Fibularis longus, Fibularis brevis, Fibularis tertius |
| Muscle Location | Lateral compartment of the leg (Fibularis longus and Fibularis brevis), Anterior compartment of the leg (Fibularis tertius) |
| Muscle Function | Move the sole of the foot outward (eversion), Fibularis longus and brevis extend the foot downward (plantar flexion), Fibularis tertius pulls the foot upward (dorsiflexion) |
| Innervation | Superficial fibular nerve (Fibularis longus and Fibularis brevis), Deep peroneal nerve (Fibularis tertius) |
| Blood Supply | Fibular artery (Fibularis longus and Fibularis brevis), Anterior tibial artery (Fibularis tertius) |
| Tendons | Peroneal tendons (Fibularis longus and Fibularis brevis), Extensor digitorum longus (Fibularis quartus) |
| Pathology | Tendinosis, Tendon tears, Tenosynovitis, Subluxation, Dislocation, Peroneal tendinopathy |
| Treatment | Conservative treatment, Surgical treatment (tendon debridement, tenosynovectomy, end-to-end repair, side-to-side anastomosis, Pulvertaft weave, tendon transfer, allograft reconstruction) |
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What You'll Learn
- The peroneal muscles are made up of the peroneus longus and peroneus brevis
- The peroneal muscles originate in the lateral compartment of the lower leg
- The peroneal muscles are innervated by the superficial peroneal nerve
- Peroneal tendon injuries are common in young, active individuals
- Peroneal tendons are encapsulated in a vascular-rich paratenon
The peroneal muscles are made up of the peroneus longus and peroneus brevis
The peroneal muscles are indeed made up of the peroneus longus and peroneus brevis. These muscles originate within the lateral compartment of the lower leg. The peroneal tendons are extensions of the peroneus longus and peroneus brevis muscles. The peroneus longus muscle originates from the lateral tibial condyle and the head of the fibula, while the peroneus brevis originates from the middle third of the fibula and the intermuscular septum. The peroneus longus is the largest of the fibularis muscles and lies superficial to the peroneus brevis.
The peroneal muscles are innervated by the superficial peroneal nerve, which is a branch of the common fibular nerve and originally stems from the sciatic nerve. The blood supply for the lateral leg compartment is from the posterior peroneal artery and branches of the medial tarsal artery. The peroneal tendons pass posterior to the lateral malleolus within a common synovial sheath, held in place by the superior peroneal retinaculum.
The peroneal muscles are susceptible to various pathologies, including tendinosis, tendon tears, tenosynovitis, subluxation, and dislocation. These issues can cause posterolateral ankle pain and instability. Peroneal tendon injuries are commonly seen in young, active individuals who participate in sports such as football, soccer, and running.
The peroneus longus and brevis muscles work together to plantarflex and evert the foot at the ankle. The peroneus longus also acts to produce plantarflexion of the first ray of the foot. The peroneus brevis is particularly relevant to occupational medicine due to its frequent involvement in lateral ankle sprains. Its tendon, along with the tendon of the peroneus longus, is the most commonly dislocated tendon in the ankle.
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The peroneal muscles originate in the lateral compartment of the lower leg
The peroneal muscles, also known as the fibular muscles, are indeed muscles. They are made up of two muscles: the fibularis longus and the fibularis brevis. These muscles originate in the lateral compartment of the lower leg.
The fibularis longus is the larger of the two peroneal muscles. It originates from the head and proximal two-thirds of the lateral surface of the shaft of the fibula, as well as the adjacent surface of the intermuscular septum. It extends down the lateral compartment of the lower leg, where it tapers into a long tendon that descends into the foot. The tendon passes behind the lateral malleolus and reaches the plantar compartment of the foot. It then moves along the lateral edge of the foot, inserting itself on the plantar side of the medial cuneiform and first metatarsal bone. The fibularis longus is responsible for plantar flexion and eversion of the foot, as well as providing support to the longitudinal and transverse arches of the foot.
The fibularis brevis, on the other hand, originates from the distal two-thirds of the lateral surface of the fibula and the adjacent intermuscular septum. Its muscle fibres descend towards the foot, giving off a tendon just above the ankle. This tendon passes behind the lateral malleolus and inserts itself on the tuberosity of the fifth metatarsal bone. The function of the fibularis brevis is eversion of the foot.
The peroneal muscles are innervated by the superficial peroneal nerve, which is a branch of the common fibular nerve. The blood supply to these muscles comes from the posterior peroneal artery and branches of the medial tarsal artery. The peroneal tendons are extensions of the peroneal muscles and play a crucial role in the movements of the ankle joint and support of the foot.
Injuries to the peroneal muscles and tendons are common, especially in young, active individuals and those participating in sports such as football, soccer, and running. These injuries can cause lateral ankle pain and may lead to ankle instability. Accurate diagnosis of peroneal tendon injuries can be challenging, as it may be difficult to distinguish tendon pathology from lateral ankle ligament issues based solely on clinical findings.
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The peroneal muscles are innervated by the superficial peroneal nerve
The peroneal muscles are indeed muscles, specifically the peroneus longus and brevis muscles, which make up the lateral compartment of the leg. The peroneal muscles originate within the lateral compartment of the lower leg, and their tendons pass posterior to the lateral malleolus within a common synovial sheath. The peroneal tendons are extensions of the peroneus longus and peroneus brevis muscles.
The superficial peroneal nerve exits the peroneal muscles on the anterolateral aspect of the lower leg, approximately 12 cm above the ankle joint, at a defect in the crural fascia (also known as the deep fascia of the leg). The medial and intermediate dorsal cutaneous nerves emerge inferiorly from the superficial peroneal nerve, with the medial dorsal cutaneous nerve being the larger of the two. These nerves provide sensory innervation to the leg's anterolateral aspect, the dorsum of the foot, and the dorsal aspect of the toes, except the 1st interdigital space, which is innervated by the deep peroneal nerve.
The superficial peroneal nerve has both motor and sensory components. The motor fibres innervate the leg's lateral compartment muscles, specifically the peroneus longus and peroneus brevis. Motor stimulation of these muscles is primarily responsible for eversion and mild plantar flexion of the foot. When the superficial fibular nerve is paralysed, the pronation of the foot is severely restricted, and the supination predominates so that during the lifting of the foot, it simultaneously drifts medially (equinovarus position).
Common peroneal nerve injuries can cause foot drop, which can manifest as the foot slapping the ground when walking, due to paralysis of the ankle and foot extensors. Lateral foot drop is more characteristic of superficial peroneal nerve damage, which weakens the muscles that evert the foot. Peroneal tendon injuries are commonly seen in young, active individuals who participate in sports such as football, soccer, and running.
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Peroneal tendon injuries are common in young, active individuals
The peroneal muscles are the two muscles of the lateral (fibular, peroneal) compartment of the leg. The peroneal muscles originate within the lateral compartment of the lower leg and include the peroneus longus and peroneus brevis muscles. The peroneal tendons are extensions of these muscles that make up the lateral compartment of the leg. The peroneus longus tendon turns at the retromalleolar region and in the cuboid tunnel. The peroneal tendons receive their blood supply from the peroneal artery and the tibialis anterior artery.
The common symptoms of peroneal tendonitis include pain and swelling in the peroneal tendons, which usually go away after several weeks of conservative treatments. However, if left untreated, peroneal tendonitis can progress to a tendon rupture. Other symptoms include thickened tendons, with a mass or nodule that moves with the tendon, and ankle pain along the length of the tendon. The pain gets worse with physical activity and can be felt around the tendon, along with swelling, redness, or warmth.
Peroneal tendon injuries can be treated with conservative methods such as bracing, immobilization, medication, physical therapy, and the RICE method. Surgical treatment may be required for peroneal tendon tears. Surgical techniques may include tendon debridement and/or tenosynovectomy for tendinitis.
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Peroneal tendons are encapsulated in a vascular-rich paratenon
The peroneal tendons are extensions of the peroneus longus and peroneus brevis muscles that make up the lateral compartment of the leg. The peroneal muscles originate within the lateral compartment of the lower leg. The peroneus longus muscle, along with the Fibularis brevis muscle, make up the lateral compartment of the lower leg. The Fibularis longus lies superficial to the Fibularis brevis and is the largest of the Fibularis muscles. The peroneal muscles are innervated by the superficial peroneal nerve, which is a branch of the common fibular nerve stemming from the sciatic nerve.
The peroneal tendons are encapsulated in a vascular-rich paratenon. However, there is a short area of avascularity where the tendons bend around bony prominences. This includes both tendons in the retromalleolar groove and the peroneus longus around the cuboid. The peroneal tendons share a common synovial sheath and together they course behind the fibula through the retromalleolar groove. In the groove, the peroneus longus is positioned posterior and lateral to the peroneus brevis tendon. The peroneal retinaculum forms the posterolateral boundary of the grove and holds the tendons in place as they slide within the groove, preventing lateral migration and subluxation over the fibula.
The peroneal tendons play a critical role in stabilizing the foot and ankle, especially in athletes with high demands on lateral ankle strength. The primary biomechanical purpose of the peroneal tendons is to evert the hindfoot and keep the first metatarsal purchased to the ground. The peroneal tendons balance the forces exerted by the tibialis posterior, flexor hallucis longus, and flexor digitorum longus.
Peroneal tendon injuries are most commonly present in patients who are young, active, and those who participate in sports such as football, soccer, and running. Peroneal tendon tears are often associated with lateral ankle injuries and can lead to weakness and instability. The spectrum of pathology involving the peroneal tendons includes tendinosis, tendon tears, tenosynovitis, as well as subluxation or dislocation, all of which are potential causes of posterolateral ankle pain.
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Frequently asked questions
The peroneal muscles, also known as the fibular muscles or peroneus muscles, are a group of muscles in the lateral compartment of the lower leg. The muscle group typically includes the fibularis longus, fibularis brevis, and fibularis tertius.
All three muscles work to move the sole of the foot outward, away from the body (eversion). The longus and brevis also extend the foot downward away from the body (plantar flexion), while the tertius muscle pulls the foot upward toward the body (dorsiflexion).
Peroneal tendon injuries are common in young, active individuals and those who play sports such as football, soccer, and running. The injuries can include tendinosis, tendon tears, tenosynovitis, subluxation, and dislocation, which can cause posterolateral ankle pain and ankle instability.
Conservative treatment may be attempted first, but if this fails or in the case of a complete tear, surgical treatment may be required. Surgical techniques include tendon debridement, tenosynovectomy, end-to-end repair, side-to-side anastomosis, Pulvertaft weave, tendon transfer, or allograft reconstruction.
