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.
Medial Approach to Calcaneus

Superficial dissection

  • 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

Deep dissection

  • 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.

Dangers

The structures at risk during the medial approach to calcaneus include:

  1. Medial calcaneal nerve.
  2. Nerve to abductor digiti minimi muscle.

References

  • Campbel’s Operative Orthopaedics book 12th