Fibular trochlea hypertrophy
Updates to Article Attributes
PeronealFibular trochlea hypertrophy, also known as peroneal tubercle hypertrophy refers to the presence of an unusually large fibular trochlea.
Epidemiology
Dependent on the definition, the incidence of enlarged peroneal tuberclefibular trochlea has been reported to be from 20.5 - 24% 2.
Clinical presentation
Complications
-
the enlarged
tuberclefibular trochlea may impinge upon theperoneusfibular tendons and result in stenosing tenosynovitisthe tendon sheaths may show thickening and fluid within them
at times an adventitial bursa can develop over the tubercle due to repeated friction, which may become symptomatic
Radiographic features
Two bony projections or protuberances may be seen from the lateral wall of the calcaneus – the peroneal tuberclefibular trochlea and the retrotrochlear eminence.
The peroneal tubercleperoneusthe fibularis brevis and the peroneusfibularis longus. The common synovial sheath that covers the two tendons proximal to the tubercle divides into two slips to individually enclose the peronealfibular tendons at the tubercle and beyond. The peroneusfibularis brevis lies superior to the tubercle, and the peroneusfibularis longus lies inferior to the tubercle.
The retrotrochlear eminence is located posterior to the peroneal tuberclefibular trochlea and the peronealfibular tendons. It is seen to be prominent in individuals with hypertrophied peroneus quartus muscle, the most frequently reported accessory peronealfibular muscle. The muscle arises from the inferolateral aspect of the fibula and has variable insertions, one of them being the retrotrochlear eminence.
Some consider the height of the peroneal tuberclefibular trochlea of 5 mm or more being a cutoff for diagnosis of hypertrophic peroneal tuberclefibular trochlea 2.
Treatment and prognosis
The initial management of the condition when symptomatic is conservative, but surgical resection is indicated in those who do not respond to conservative management.
-<p><strong>Peroneal tubercle hypertrophy</strong> refers to the presence of an unusually large <a href="/articles/peroneal-tubercle">peroneal tubercle</a>.</p><h4>Epidemiology</h4><p>Dependent on the definition, the incidence of enlarged peroneal tubercle has been reported to be from 20.5 - 24% <sup>2</sup>.</p><h4>Clinical presentation</h4><h5>Complications</h5><ul>-<li>the enlarged tubercle may impinge upon the peroneus tendons and result in stenosing tenosynovitis<ul><li>the tendon sheaths may show thickening and fluid within them</li></ul>- +<p><strong>Fibular trochlea hypertrophy, </strong>also known as<strong> peroneal tubercle hypertrophy</strong> refers to the presence of an unusually large <a href="/articles/fibular-trochlea" title="Fibular trochlea">fibular trochlea</a>.</p><h4>Epidemiology</h4><p>Dependent on the definition, the incidence of enlarged <a href="/articles/fibular-trochlea" title="Fibular trochlea">fibular trochlea</a> has been reported to be from 20.5 - 24% <sup>2</sup>.</p><h4>Clinical presentation</h4><h5>Complications</h5><ul>
- +<li>
- +<p>the enlarged fibular trochlea may impinge upon the fibular tendons and result in stenosing tenosynovitis</p>
- +<ul><li><p>the tendon sheaths may show thickening and fluid within them</p></li></ul>
-<li>at times an adventitial bursa can develop over the tubercle due to repeated friction, which may become symptomatic</li>-</ul><h4>Radiographic features</h4><p>Two bony projections or protuberances may be seen from the lateral wall of the calcaneus – the peroneal tubercle and the <a href="/articles/retrotrochlear-eminence">retrotrochlear eminence</a>.</p><p>The <a href="/articles/peroneal-tubercle">peroneal tubercle</a> is present immediately inferior to the fibular malleolus, lying in between the two tendons, it separates the tendons of peroneus brevis and the peroneus longus. The common synovial sheath that covers the two tendons proximal to the tubercle divides into two slips to individually enclose the peroneal tendons at the tubercle and beyond. The peroneus brevis lies superior to the tubercle, and the peroneus longus lies inferior to the tubercle.</p><p>The retrotrochlear eminence is located posterior to the peroneal tubercle and the peroneal tendons. It is seen to be prominent in individuals with hypertrophied <a href="/articles/peroneus-quartus-muscle">peroneus quartus muscle</a>, the most frequently reported accessory peroneal muscle. The muscle arises from the inferolateral aspect of the fibula and has variable insertions, one of them being the retrotrochlear eminence. </p><p>Some consider the height of the peroneal tubercle of 5 mm or more being a cutoff for diagnosis of hypertrophic peroneal tubercle<sup> 2</sup>.</p><h4>Treatment and prognosis</h4><p>The initial management of the condition when symptomatic is conservative, but surgical resection is indicated in those who do not respond to conservative management.</p>- +<li><p>at times an adventitial bursa can develop over the tubercle due to repeated friction, which may become symptomatic</p></li>
- +</ul><h4>Radiographic features</h4><p>Two bony projections or protuberances may be seen from the lateral wall of the calcaneus – the fibular trochlea and the <a href="/articles/retrotrochlear-eminence">retrotrochlear eminence</a>.</p><p>The fibular trochlea is present immediately inferior to the fibular malleolus, lying in between the two tendons, it separates the tendons of the <a href="/articles/peroneus-brevis-muscle" title="Fibularis brevis">fibularis brevis</a> and the <a href="/articles/fibularis-longus-muscle-1" title="Fibularis longus muscle">fibularis longus</a>. The common synovial sheath that covers the two tendons proximal to the tubercle divides into two slips to individually enclose the fibular tendons at the tubercle and beyond. The fibularis brevis lies superior to the tubercle, and the fibularis longus lies inferior to the tubercle.</p><p>The retrotrochlear eminence is located posterior to the fibular trochlea and the fibular tendons. It is seen to be prominent in individuals with hypertrophied <a href="/articles/peroneus-quartus-muscle">peroneus quartus muscle</a>, the most frequently reported accessory fibular muscle. The muscle arises from the inferolateral aspect of the fibula and has variable insertions, one of them being the retrotrochlear eminence. </p><p>Some consider the height of the fibular trochlea of 5 mm or more being a cutoff for diagnosis of hypertrophic fibular trochlea<sup> 2</sup>.</p><h4>Treatment and prognosis</h4><p>The initial management of the condition when symptomatic is conservative, but surgical resection is indicated in those who do not respond to conservative management.</p>
References changed:
- 1. Saupe N, Mengiardi B, Pfirrmann C, Vienne P, Seifert B, Zanetti M. Anatomic Variants Associated with Peroneal Tendon Disorders: MR Imaging Findings in Volunteers with Asymptomatic Ankles. Radiology. 2007;242(2):509-17. <a href="https://doi.org/10.1148/radiol.2422051993">doi:10.1148/radiol.2422051993</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17255421">Pubmed</a>
- 2. Lui T. Endoscopic Resection of Peroneal Tubercle. Arthrosc Tech. 2017;6(5):e1489-93. <a href="https://doi.org/10.1016/j.eats.2017.06.006">doi:10.1016/j.eats.2017.06.006</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29354463">Pubmed</a>
- 3. Ochoa L & Banerjee R. Recurrent Hypertrophic Peroneal Tubercle Associated with Peroneus Brevis Tendon Tear. J Foot Ankle Surg. 2007;46(5):403-8. <a href="https://doi.org/10.1053/j.jfas.2007.05.006">doi:10.1053/j.jfas.2007.05.006</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17761327">Pubmed</a>
- 1. Saupe N, Mengiardi B, Pfirrmann CW et-al. Anatomic variants associated with peroneal tendon disorders: MR imaging findings in volunteers with asymptomatic ankles. Radiology. 2007;242 (2): 509-17. <a href="http://dx.doi.org/10.1148/radiol.2422051993">doi:10.1148/radiol.2422051993</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/17255421">Pubmed citation</a><div class="ref_v2"></div>
- 2. Lui TH. Endoscopic Resection of Peroneal Tubercle. (2017) Arthroscopy techniques. 6 (5): e1489-e1493. <a href="https://doi.org/10.1016/j.eats.2017.06.006">doi:10.1016/j.eats.2017.06.006</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29354463">Pubmed</a> <span class="ref_v4"></span>
- 3. Ochoa LM, Banerjee R. Recurrent hypertrophic peroneal tubercle associated with peroneus brevis tendon tear. (2007) The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 46 (5): 403-8. <a href="https://doi.org/10.1053/j.jfas.2007.05.006">doi:10.1053/j.jfas.2007.05.006</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/17761327">Pubmed</a> <span class="ref_v4"></span>
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