背景:副比目鱼肌(ASM)是一种罕见的先天性变异,几乎无症状,但是最近有几篇论文描述了有症状的ASM。这种情况的临床特征与tal管综合征(TTS)相似,包括踝关节内侧周围的疼痛和麻木。ASM通常起源于腓骨或比目鱼肌,并插入跟腱或跟骨。通常,它被确定为后内侧肿胀,并通过磁共振成像明确诊断。在大多数情况下,治疗是观察,但是如果症状严重,可以考虑手术切除。
方法:一名23岁的韩国男性士兵主诉双侧足踝部疼痛,跟腱内侧肿胀,右侧更为明显。症状首次出现在本次演讲前10个月踢足球后,体力消耗后恶化,休息后松了一口气。他没有病史,他家里没有人有这种情况。实验室结果是非特异性的。进行了一些测试以排除常见疾病,例如肿瘤或TTS。然而,核磁共振显示双脚有粗大的辅助比目鱼肌,尽管患者抱怨身体活动期间右侧疼痛更严重。因此,采用手术切除。在手术中,在跟腱前方发现了一个大的副比目鱼肌,与正常比目鱼肌明显插入。手术后12个月,没有疼痛,麻木,或者右脚或脚踝肿胀,没有复发的证据,病人可以做所有的体育活动。
结论:如果患者有疼痛,应将副比目鱼肌添加到鉴别诊断列表中,后内侧脚踝的鞋底麻木或肿胀。
BACKGROUND: Accessory soleus muscle (ASM) is a rare congenital variation that is almost asymptomatic, but several papers have recently described symptomatic ASM. The clinical features of this condition are similar to tarsal tunnel syndrome (TTS) and include pain and numbness around the medial side of the ankle. ASM commonly originates from the fibula or soleus muscle and inserts into the Achilles tendon or calcaneus. Usually, it is identified as posteromedial swelling and definitely diagnosed by magnetic resonance imaging. In most cases, treatment is observation, but surgical excision can be considered if symptoms are severe.
METHODS: A 23-year-old male Korean soldier presented with complaints of bilateral foot and ankle pain and a swelling medial to the Achilles tendon that was more pronounced on the right side. Symptoms first occurred after playing soccer 10 mo before this presentation, worsened after physical exertion, and were relieved by rest. He had no medical history, and no one in his family had the condition. Laboratory results were non-specific. Several tests were performed to exclude common diseases such as tumors or TTS. However, MRI revealed a bulky accessory soleus muscle in both feet, though the patient complained of more severe pain on the right side during physical activity. Accordingly, surgical resection was adopted. At surgery, a large accessory soleus muscle was noted anterior to the Achilles tendon with distinctive insertion from a normal soleus muscle. At 12 mo after surgery, there was no pain, numbness, or swelling of the right foot or ankle, no evidence of recurrence, and the patient could do all sports activities.
CONCLUSIONS: Accessory soleus muscle should be added to the list of differential diagnosis if a patient has pain, sole numbness or swelling of the posteromedial ankle.