Medial Approach to Calcaneus

The Medial Approach to Calcaneus is mainly used for open reduction and internal fixation of calcaneus fractures.

See Also: Ankle Anatomy

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.

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