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The accessory soleus muscle is an uncommon accessory muscle of the ankle, found in approximately 3% of people. It is a rare supernumerary anatomical variant that commonly presents as a posteromedial ankle swelling, which may become painful during physical activity. The accessory soleus muscle arises from the deep surface of the soleus or from the fibula and descends anteriorly to the calcaneal (Achilles) tendon. The soleus muscle itself is a wide, flat leg muscle found on the posterior leg, running from just below the knee to the heel. It is one of the antigravity muscles that help maintain an upright posture in humans.
| Characteristics | Values |
|---|---|
| Prevalence | 0.5% to 6.0% of the population |
| Typical presentation | Soft mass in the posteromedial distal third of the leg |
| Increase in size | During physical activity, especially plantar flexion |
| Pain | 67% of reported cases |
| Treatment | Conservative; fasciotomy if compartment syndrome is present |
| Symptoms | Claudication or nerve compression |
| Location | Under the gastrocnemius muscle, in the posterior upper third of the fibula |
| Origin | Deep surface of the soleus or from the fibula |
| Insertion | Calcaneal tendon or the superior or medial aspect of the calcaneus |
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What You'll Learn
- The accessory soleus muscle is an uncommon accessory muscle of the ankle
- It is a rare anatomical variant, characterised by an additional muscle
- It is usually asymptomatic and detected during imaging for unrelated reasons
- When symptomatic, it presents as a soft mass in the posteromedial distal third of the leg?
- It is associated with pain and edema during periods of prolonged exercise
The accessory soleus muscle is an uncommon accessory muscle of the ankle
The accessory soleus muscle is an accessory muscle of the calf that is rarely present in humans, but when it is, it is the most common accessory muscle of the ankle. It is an anatomical variant characterised by an additional distinct muscle encountered along a normal soleus muscle. The soleus muscle is a wide, flat leg muscle found on the posterior leg, running from just below the knee to the heel. The accessory soleus muscle arises from the deep surface of the soleus or from the fibula and descends anteriorly to the calcaneal (Achilles) tendon. It is present in approximately 3% of people, though some sources place this figure at between 0.7% and 5.5%. It usually appears as a distant belly, medial to the Achilles tendon.
The accessory soleus muscle can be asymptomatic, and therefore only detected during imaging for an unrelated reason. However, it can also be symptomatic, presenting as a soft mass in the posteromedial distal third of the leg, which increases in size with physical activity, particularly plantar flexion. Pain is another common symptom, affecting two-thirds of patients, and worsening with jumping and running. This pain is likely due to chronic compartment syndrome, as the accessory soleus muscle increases in size during physical activity. Neuropathy from compression of the posterior tibial nerve has also been reported.
The accessory soleus muscle can be diagnosed using MRI, which is considered the most specific and sensitive test. It appears as an oval or fusiform, well-defined image with its own fascia. Treatment is usually conservative, but when the muscle causes compartment syndrome, a fasciotomy should be performed. If a patient has symptoms of claudication or nerve compression, a complete excision of the muscle is required.
The accessory soleus muscle is a rare supernumerary anatomical variant. It may present with a painful syndrome characterised by pain and paresthesia of the ankle and foot, mimicking tarsal tunnel syndrome (TTS). In some cases, the muscle may be painful without any noticeable swelling.
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It is a rare anatomical variant, characterised by an additional muscle
The accessory soleus muscle is a rare anatomical variant, characterised by an additional muscle. It is an accessory muscle of the calf that is rarely present in humans—found in only about 3% of the population—but it is the most common accessory muscle of the ankle.
The accessory soleus muscle arises from the deep surface of the soleus or from the fibula and descends anteriorly to the calcaneal (Achilles) tendon. It inserts on the anterior aspect of the soleus muscle or on the posterior aspect of the tibia or the muscles of the deep posterior compartment. It lies anterior to the calcaneal tendon and terminates on the calcaneal tendon or the superior or medial aspect of the calcaneus via fleshy fibres or a distinct tendon.
The soleus muscle, meanwhile, is a wide, flat leg muscle found on the posterior leg. It runs from just below the knee to the heel and lies immediately deep to the gastrocnemius. The soleus and gastrocnemius muscles work together to constitute a chief plantar flexor. Their contraction results in the plantar flexion of the upper ankle joint, enabling the lifting of the heel against gravity when walking or jumping. The soleus is the main muscle responsible for plantar flexion when the knee is flexed.
Patients with an accessory soleus muscle may be asymptomatic, or they may experience pain and edema during periods of prolonged exercise. The usual presentation is a soft mass in the posteromedial distal third of the leg, which increases in size with activity, particularly plantar flexion.
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It is usually asymptomatic and detected during imaging for unrelated reasons
The accessory soleus muscle is an uncommon accessory muscle of the calf, present in only around 3% of people. It is characterised by an additional distinct muscle encountered along a normal soleus muscle. The soleus muscle is a wide, flat leg muscle found on the posterior leg, which runs from just below the knee to the heel.
The accessory soleus muscle is usually asymptomatic, with most reported cases being associated with symptoms. However, there are some patients who present with only asymptomatic swelling. When symptomatic, the usual presentation is a soft mass in the posteromedial distal third of the leg. This mass increases in size with activity, particularly plantar flexion. Pain is another common symptom, which worsens with jumping and running.
Due to its rarity, the accessory soleus muscle is usually detected during imaging for unrelated reasons. MRI is considered the most specific and sensitive test for diagnosis. The accessory soleus muscle appears as an oval or fusiform, well-defined image with its own fascia.
In some cases, the accessory soleus muscle can be torn, either partially or completely. This is an uncommon injury that can mimic other pathologies, such as lesions of the soleus muscle, Achilles tendon, or deep vein thrombosis. Therefore, radiologists should be aware of the physiological and pathological imaging findings to correctly interpret ankle injuries.
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When symptomatic, it presents as a soft mass in the posteromedial distal third of the leg
The accessory soleus muscle is a rare anatomical variant, present in only 3% of people. It is an accessory muscle of the calf, lying anterior to the calcaneal tendon. When symptomatic, it presents as a soft mass in the posteromedial distal third of the leg. This mass increases in size with physical activity, particularly plantar flexion.
The accessory soleus muscle arises from the deep surface of the soleus or from the fibula and descends anteriorly to the calcaneal (Achilles) tendon. The soleus muscle itself is a wide, flat leg muscle found on the posterior leg. It runs from just below the knee to the heel and is responsible for plantar flexion, enabling the lifting of the heel against gravity when walking or jumping.
When symptomatic, the accessory soleus muscle can cause pain, particularly during physical activity. This pain may worsen with jumping and running. The mass may also increase in size during physical activity, particularly plantar flexion. In some cases, the accessory soleus muscle may present with a painful syndrome, characterised by pain and paresthesia of the ankle and foot, mimicking tarsal tunnel syndrome.
The presence of the accessory soleus muscle is typically detected through imaging techniques such as X-ray, ultrasound, and magnetic resonance imaging (MRI). MRI is considered the most specific and sensitive test for diagnosis. Treatment options depend on the specific symptoms and complications presented by the patient. In cases of compartment syndrome, fasciotomy may be performed. If patients experience claudication or nerve compression, a complete excision of the muscle may be required.
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It is associated with pain and edema during periods of prolonged exercise
The accessory soleus muscle is an accessory muscle of the calf that is rarely present in humans, found in only about 3% of the population. It is, however, the most common accessory muscle of the ankle. The muscle inserts on the anterior aspect of the soleus muscle or on the posterior aspect of the tibia or the muscles of the deep posterior compartment. It lies anterior to the calcaneal tendon and terminates on the calcaneal tendon or the superior or medial aspect of the calcaneus via fleshy fibres or a distinct tendon.
The accessory soleus muscle is associated with pain and edema during periods of prolonged exercise. This pain is likely due to chronic compartment syndrome, as the accessory soleus muscle increases in size during physical activity. The source of pain could also be exercise-induced intermittent claudication, which is relieved with rest. This occurs when the ASM is insufficiently supplied with blood by the posterior tibial artery during exercise. Additionally, the pain could be caused by compression neuropathy due to the proximity of the ASM to the tibial nerve. This is supported by the fact that the symptoms tend to only be present during exercise.
The pain associated with the accessory soleus muscle is especially common in athletes. Two-thirds of patients with the accessory soleus muscle experience pain, which worsens with jumping and running. This pain could be a result of a partial tear or strain of the muscle.
The accessory soleus muscle can be detected with an MRI, which is considered the most specific and sensitive test for diagnosis. Treatment for the pain includes rest, NSAIDs, stretching, deep tissue massage, and eccentric loading. Botulinum toxin has also been shown to reduce muscle mass and symptoms.
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Frequently asked questions
The accessory soleus muscle is located underneath the gastrocnemius muscle, in the posterior upper third of the fibula. It is an accessory muscle of the calf, which is rarely present in humans.
The accessory soleus muscle is a rare congenital variation that is usually asymptomatic. However, it can be associated with pain and edema during periods of prolonged exercise.
The accessory soleus muscle is present in approximately 3% of the population, with a range of 0.7% to 5.5%. It is more commonly observed in females, with a ratio of 2:1.
The accessory soleus muscle is typically diagnosed through magnetic resonance imaging (MRI), which reveals a bulky accessory soleus muscle.
