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FIBULARIS MUSCLE AND TENDON INJURIES If you've strained one of your fibularis tendons, the pain in your ankle will let you know something is wrong, but you'll probably have a hard time identifying the fibularis as a source of the trouble. That's because this injury tends to get overshadowed by a much more common and better-known cause of pain: a lateral ankle sprain. In fact, the fibularis usually doesn't get injured in isolation. Typically the ankle is sprained as well. But when a fibularis muscle or tendon is involved, simply treating the sprained ligaments will not fully resolve the pain. There are three fibularis muscles: the fibularis longus, brevis, and tertius (Image 1). The fibularis tertius is a very small, weak muscle that is not usually injured. The two stronger muscles begin at the lateral lower leg, just inferior to the knee, and travel down toward the ankle. Their tendons begin just superior to the ankle and wrap around the back of the lateral malleolus in a little groove, where they are held in place by a band-like structure called the superior fibular retinaculum (formerly Fibularis longus Fibularis brevis Fibularis longus tendon Fibularis tertius tendon Fibularis brevis tendon Image source: Sobotta: Atlas der Anatomie des Menschen, © Elsevier GmbH, Urban & Fischer Verlag Munich the superior peroneal retinaculum). These two tendons are wrapped in a sheath until they part company, with the longus tendon running through the foot and attaching to the first metatarsal bone and the brevis attaching to the fifth metatarsal bone. The major function of the fibularis muscle-tendon units is to stabilize your lower legs as you walk so that your ankles don't wobble and give way laterally. The longus ("the long one") helps you to move your foot in eversion when the foot is plantar flexed, while the brevis ("the short one") lets you evert the foot when it's in a dorsiflexed position. Of course, whenever you move into eversion, both of these muscles are active, but depending on the foot position, one will be more dominant. The fibularis longus and brevis act as a counterbalance to the posterior tibialis muscle, which I discussed in a previous article ("Posterior Tibialis Injuries," September/October 2009, page 102). Together, they are referred to as the stirrup muscles. Imagine sitting on a horse and pressing down on just one stirrup—you would be unstable and more likely to fall off. Likewise, if your fibularis and posterior tibialis muscles are not in balance, you are much more likely to fall and sprain your ankle. These structures are placed under stress whenever you walk on uneven ground, climb on rocks, go skiing, or run quickly from side to side as you might in a tennis or basketball game. connect with your colleagues on massageprofessionals.com 91