Issue link: https://www.massageandbodyworkdigital.com/i/68185
ESSENTIAL SKILLS A Muscle by Any Other Name… You may sometimes hear the fibularis structures referred to as the peroneus (or peroneal) muscles and tendons. These terms are derived from the Greek word perone, which refers to the pin of a brooch or a buckle. Over the years, the word fibularis (referring, of course, to the fibula) has come to predominate. It is now the preferred term for these structures. Injuries to the fibularis tendons may cause pain at the lateral aspect of the lower leg just above or below the lateral malleolus or at the outside of the foot below the ankle (Image 2). If the muscle belly is injured, pain is felt between the lateral knee and the lateral ankle. The most common site of injury is directly posterior to the lateral malleolus. HOW AND WHY THESE INJURIES OCCUR Fibularis muscle and tendon injuries may occur suddenly as a person walks on very uneven ground, steps into a hole while walking or running, slides into second base, or gets tripped in a soccer match, or in any other accident in which the ankle turns with the foot beneath the body. More frequently, though, the injury develops slowly over time as a result of overuse or a chronic misalignment of the foot. Our feet are extremely complex structures— containing 26 bones, 20 different muscles, and more than 50 ligaments— and they need to support the entire weight of our bodies. There are many opportunities for things to go wrong. For instance, if some of the bones in the feet are out of alignment or if the medial arches are congenitally high, the feet may naturally begin to Fibularis longus tendon Fibularis brevis tendon pronate, causing the arches to fall. When this happens to people, they feel like they are walking with their knees turned inward, as though they are pigeon-toed. They will tend to compensate by turning their feet out 10, 20, or 30 degrees and walking in this misaligned position where the feet are angled out and the knees are pointing straight ahead. That creates a torque in the knees, ankles, and hips, causing stress to ricochet throughout the body, all the way up to the neck. In this position, the weight going through the feet and legs shifts medially so that more of the body's weight falls onto the metatarsal of the great toe, the medial ligaments of the knee, and the muscles of the medial leg—particularly the medial aspects of the soleus and gastrocnemius and the posterior tibialis muscles. Much less weight is supported by the fibularis longus and brevis. As a result, all of these muscles and tendons become more vulnerable to injury. While the medial structures fatigue from overuse, the lateral structures begin to weaken and atrophy. When a weakened fibularis muscle-tendon unit is then suddenly called upon to do its job, it can easily tear under the strain. Fibularis injuries occur frequently in athletes, dancers, and runners. 92 massage & bodywork september/october 2010 Typically the first sign is an ache in the lateral lower leg or just behind the lateral malleolus. Over time, the person feels increasing pain and may begin to limp if the injury becomes severe. As mentioned earlier, pain in the ankle region is frequently confused with (and frequently coexists with) a lateral ankle sprain. INJURY VERIFICATION When one of the fibularis tendons is strained, it often hurts just to walk or rise up on the ball of the foot. Usually the greatest pain is felt when everting the foot against resistance. TEST 1. RESISTED EVERSION IN DORSIFLEXION (TESTS THE FIBULARIS BREVIS) Sitting at the base of the table facing the client's foot, place your medial hand under the heel for support and your lateral hand on the lateral aspect of the foot. Then, ask the client to forcefully push outward (laterally), keeping the foot in a dorsiflexed position as you push medially with equal and opposite force. If the fibularis brevis is injured, the client will feel pain at the lateral ankle or in the lateral lower leg (Image 3).