Medial Approach to Calcaneus

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

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.

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

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