PMC7516695_01
Preoperative images of the patient's right ankle presented in the first case. (a) A swelling is visible in the posteromedial part of the right ankle, which is more prominent in plantar flexion. (b) Obliteration of Kager's fat pad visible on the plain lateral radiograph of the right ankle is pointed by a white arrow. (c) T1-weighted sagittal MR image of the right ankle. Accessory soleus muscle (ASM) is marked with an asterisk (*), and obliteration of the Kager's fat pad is pointed by a white arrow. (d) T2-weighted axial MR image of the right ankle. ASM is marked with an asterisk (*), and neurovascular bundle in the posteromedial part of the ankle is pointed by a white arrow. (e) T1-weighted axial MR image of the right ankle. ASM is marked with an asterisk (*), and elevation of the skin and subcutaneous tissue is pointed by a white arrow. (f) T1-weighted coronal MR image of the right ankle. ASM is marked with an asterisk (*), the elevation of the skin and subcutaneous tissue is pointed by a white arrow, and muscular insertion of the ASM on the medial side of the calcaneus is pointed by a black arrow.
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fig1
Physical examination revealed painful posteromedial ankle swelling (Figure 1).
Intraoperative images of the patient presented in the first case. (a) Incision was made just medial to the Achilles tendon proximally and extended down to the proximal border of the tarsal tunnel. Accessory soleus muscle (ASM) is visible right below the skin and subcutaneous tissue. (b) ASM was bluntly dissected and separated from the surrounding structures. (c) Neurovascular bundle of the posteromedial part of the ankle is visualized. Neurovascular bundle is pointed by a white arrow. (d) The completely resected muscle that is approximately 7 cm long. A muscular distal portion is marked by a Kocher's forceps.
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fig2
Achilles tendon proximally and extended down to the proximal border of the tarsal tunnel (Figure 2). ASM was identified, bluntly dissected, and completely resected.
PMC7516695_02
Preoperative images of the patient's right ankle presented in the second case. (a) Obliteration of Kager's fat pad visible on the plain lateral radiograph of the right ankle is pointed by a white arrow, and insula compacta is pointed by a black arrow. (b) T1-weighted sagittal MR image of the right ankle. Accessory soleus muscle (ASM) is marked with an asterisk (*), and obliteration of the Kager's fat pad is pointed by a white arrow. (c) T2-weighted sagittal MR image of the right ankle. ASM is marked with an asterisk (*), where shrinkage of the muscle can be visualized towards its insertion. (d) T2-weighted axial MR image superior to the right ankle. ASM is marked with an asterisk (*). In this plane, the muscle is positioned closest to the neurovascular bundle that is pointed by a white arrow. (e) T1-weighted axial MR image of the right ankle. Tendinous insertion of the ASM on the medial side of the calcaneus is pointed by a white arrow, and insula compacta in the calcaneus is pointed by a black arrow. (f) T1-weighted axial MR image of the right ankle. ASM is marked with an asterisk (*), tendinous insertion of the ASM on the medial side of the calcaneus is pointed by the white arrow, and insula compacta in the calcaneus is pointed by a black arrow. No elevation of the skin and subcutaneous tissue is visible.
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fig3
In the meantime, she presented to our outpatient clinic, where an orthopedic surgeon issued a plain radiograph of the right ankle, and a dense area was noted in the right calcaneus (Figure 3).
Intraoperative images of the patient presented in the second case. (a) Incision was made just medial to the Achilles tendon proximally and extended down to the proximal border of the tarsal tunnel. Accessory soleus muscle (ASM) is visible right below the skin and subcutaneous tissue. (b) ASM is elevated by a surgical pincer. Shrinkage of the muscle can be visualized towards its insertion. (c) ASM was bluntly dissected and separated from the surrounding structures. (d) The completely resected muscle that is approximately 8.5 cm long. A tendinous distal part is marked by a surgical pincer. (e) Neurovascular bundle of the posteromedial part of the ankle is visualized after resection of ASM and the flexor retinaculum. Neurovascular bundle is pointed by a white arrow.
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fig4
Achilles tendon proximally and extended down to the proximal border of the tarsal tunnel (Figure 4). ASM was identified, bluntly dissected, and separated and resected completely.