Medial Approach to Calcaneus indications:
- The Medial Approach to Calcaneus is mainly used for open reduction and internal fixation of calcaneus fractures.
Position of the Patient
- The medial approach to Calcaneus can be made with the patient supine, the knee flexed, and the foot crossed over the opposite leg.
- But it is carried out most easily with the patient prone.
Landmarks and Incision
- Begin 2.5 anterior and 4cm distal to medial malleolus:
- Carry the incision posteriorly along the medial surface of the foot
- to visualize the sustentaculum, the inicision should be 5 cm long following the neurovascular structures
- identify the posterior tibial tendon, the neurovascular bundle and the flexor hallucis tendon.
- Develop the interval between the neurovascular bundle and the flexor hallucis tendon.
- Incise the retinaculum: feel for the bump of the sustentaculum: this is immediately above the flexor hallucis tendon
- Divide the fat and fascia to define the inferior margin of abductor hallucis.
- Define the inferior margin of the abductor hallucis.
- Mobilize the muscle belly: retract it dorsally: this exposes the medial and inferomedial aspects of the body of the calcaneus.
- Continue the dissection distally by dividing the plantar aponeurosis and the muscles attaching to the calcaneus.
- Subperiostally strip muscle and plantar aponeurosis off the medial and inferior calcaneus.
The structures at risk during the medial approach to calcaneus include:
- Medial calcaneal nerve.
- Nerve to abductor digiti minimi muscle.
- Campbel’s Operative Orthopaedics book 12th