New paper: review of the supernumerary muscles of the human leg and foot

A truly obscure variant muscle: the tibiocalcaneus internus. Ramnani et al. (2025: fig. 5).

I have a new paper out:

Ramnani, A.S., Landeros, J.T., Wedel, M., Moellmer, R., Wan, S., Shofler, D.W. 2025. Supernumerary muscles in the leg and foot: A review of their types, frequency, and clinical implications. Journal of the American Podiatric Medical Association 114(6): 9pp. 

Hoo boy, this one has been a saga from almost the moment it was conceived. And in fact, the project we originally conceived was very different from the one that finally made it to print. Indulge me in a little trip down memory lane…

Anushka Ramnani and Jessica Landeros were first-year podiatry students at Western University of Health Sciences in the fall of 2019. They were interested in anatomical variation, and together we hatched a plan to survey the cadavers in the anatomy lab for all of the variant and supernumerary muscles in the lower leg and foot. (Emphasis on leg and foot together — we were looking for variant muscles that crossed the ankle joint, as opposed to intrinsic foot muscles.) We were going to start in the summer of 2020 with the donor cadavers in the summer anatomy program, and continue with the larger sample of cadavers in the fall of 2020 and the spring of 2021. Anushka and Jessica applied for a summer research fellowship, and got one. It was awarded in the spring of 2020.

You can guess what happened next: no research in the anatomy lab in the summer of 2020, or in the fall, or in the spring of 2021, because of the COVID lockdown. 

Jessica Landeros (left) and Anushka Ramnani (right) presenting their work at the 2021 APMA meeting (“The National”) in Denver.

Anushka and Jessica were not deterred. They made a very sharp pivot, which I thought was impressive at the time, and still think is impressive. Since they couldn’t survey the variant muscles of the leg in the lab, they’d survey them in the literature, and write a review paper. Crucially, although there are a host of papers on individual variant muscles, and they are all covered in textbooks like Sarrafian’s Anatomy of the Foot and Ankle, there wasn’t an up-to-date, accessible paper that pulled all the common variants together in one place. Anushka and Jessica decided to compile a paper that would serve as a field guide to supernumerary muscles in the leg and foot, one that would be useful not just for doctors of podiatric medicine but also for orthopedic surgeons, physical therapists, family practice docs — anyone who might need to include variant muscles in their differential diagnosis or care plan.

Getting the paper written, submitted, and revised took a while, because med students and anatomy professors are busy. Along the way, Anushka and Jessica presented their preliminary results at the 2021 summer conference of the American Podiatric Medical Association in Denver. The paper was finally accepted at JAPMA in May…of 2023. Then for 18 months we waited for proofs. They finally came at the end of November last year, and the paper is finally out now as an advance online publication. It’s been quite a ride, but I’m proud of the paper, proud of Anushka and Jessica, and happy to have it out.

The late David Shofler, my friend and coauthor. That smile was almost always present, and infectious. Photo from his obituary in the Claremont Courier (link).

The paper benefited greatly from the input of three of my DPM colleagues who joined us as authors: Rebecca Moellmer, Stephen Wan, and the late David Shofler. David Shofler was a friend as well as a colleague, and we’d been coauthors on my first human anatomy paper (Penera et al. 2014). He passed unexpectedly, and far too young, on May 10, 2021, of a heart attack. All of us at WesternU were still reeling from his loss when my wife Vicki passed away five days later, also a parent, also in her 40s, also of a heart attack. David had an agile mind and he was a straight-up MacGyver when it came to thinking up clever, tractable research projects for students. He was also one of the most easygoing and approachable people I’ve ever met. I miss him, and it is especially satisfying — and more than a little bittersweet — to have helped shepherd one more collaboration with him into print.

References

• Kelikian, A.S. (Ed.). 2011. Sarrafian’s Anatomy of the Foot and Ankle: Descriptive, Topographic, Functional. 3rd Ed. Lippincott Williams & Wilkins. 
• Penera, K., Manji, K., Wedel, M., Shofler, D., and Labovitz, J. 2014. Ankle syndesmotic fixation using two screws: risk of injury to the perforating branch of the peroneal artery. The Journal of Foot and Ankle Surgery 53(5):534-8.
• Ramnani, A.S., Landeros, J.T., Wedel, M., Moellmer, R., Wan, S., Shofler, D.W. 2025. Supernumerary muscles in the leg and foot: A review of their types, frequency, and clinical implications. Journal of the American Podiatric Medical Association 114(6): 9pp.