U Approach to Calcaneus indications:

  • U Approach to Calcaneus is used for open reduction and internal fixation of Calcaneus fracture.

Position of the Patient

  • Place the patient prone on the operating table.
  • Support leg on sandbag.

Landmarks and Incision

  • Make lateral incision as described in lateral approach to calcaneus.
  • Make medial incision as described in medial approach to calcaneus.
  • Connect medial and lateral incisions with a transverse posterior incision inferior to the insertion of Achilles tendon.
  • This forms a U-shaped incision around the posterior four-fifths of bone.

Internervous plane

  • There is No internervous plane for the U Approach to Calcaneus.

Deep dissection

  • Divide superficial and deep fascia.
  • Incise periosteum transversely in line with the incision.
  • Dissect subperiosteally to create U-shaped flap consisting of skin, fatty heel pad, plantar aponeurosis and muscles.
  • Elevate plantar aponeurosis and muscles off the calcaneus to expose the bone.


  • The structures at risk during U Approach to Calcaneus include:
    1. Sural nerve (lateral):
      • lies 18.8mm from the lateral border of the Achilles tendon at its insertion.
      • crosses over the lateral edge of the Achilles tendon 9.8cm above the insertion.
    2. Medial calcaneal nerve (medial).
    3. Nerve to abductor digiti minimi (medial).


  • Campbel’s Operative Orthopaedics book 12th