Fibular trochlea hypertrophy, also known as peroneal tubercle hypertrophy refers to the presence of an unusually large fibular trochlea.
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Epidemiology
Dependent on the definition, the incidence of enlarged fibular trochlea has been reported to be from 20.5 - 24% 2.
Clinical presentation
Complications
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the enlarged fibular trochlea may impinge upon the fibular tendons and result in stenosing tenosynovitis
the 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 fibular trochlea and the retrotrochlear eminence.
The fibular trochlea is present immediately inferior to the fibular malleolus, lying in between the two tendons, it separates the tendons of the fibularis brevis and the fibularis longus. 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.
The retrotrochlear eminence is located posterior to the fibular trochlea and the fibular tendons. It is seen to be prominent in individuals with hypertrophied peroneus quartus muscle, 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.
Some consider the height of the fibular trochlea of 5 mm or more being a cutoff for diagnosis of hypertrophic fibular 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.
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