Changes in bones of the foot and development of inserting tendons of the lower leg musculature in tibial aplasia

Skeleton, muscles and tendons were investigated in 3 lower legs with aplasia of the tibia. The tibiofibular joint appears to be rather a syndesmosis than a diarthrosis. In all 3 cases, talus and calcaneus are connected by a synostosis. Also in the other parts of the skeleton of the feet, synarthroses with different extensions are found. The muscles, normally originating from the tibia, have shifted their origin to the fibula. The proximal part of the inserting tendons under the retinacula is quite normal. Also, their distal part in the region of the metatarsalia and of the digits exhibits no alterations. In the region of the tarsus in which already alterations in bone formation are found, the tendons of the flexor muscles of the toes exhibit some variations. Often the muscles show a new, strong insertion into the bones of the tarsus. The normal connection between the proximal and distal parts of the tendons is sometimes still indicated by a thin bundle of collagenous fibers. In all 3 cases, the tibialis anterior muscle inserts into the distal part of the tendons of the flexor muscles of the toes, indicating that there are also connections between tendons of muscles from different blastemas.