| Indications |
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| Positioning |
- Place patient prone
- Support leg on sandbag
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| 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
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| 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
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| Cincinnatti Incision |
| Indications |
- Clubfoot release
- tendo Achilles lengthening or advancement
- one-stage posteromedial release (Turco procedure)
- Correction of congenital vertical talus
- Subtalar stabilization
- Talectomy
- Excision of accessory navicular
- Excision of calcaneonavicular bar
- Treatment of insertional Achilles tendinopathy
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| Incision |
- Begin anteromedially, at the navicular-cuneiform joint
- Carry the incision posteriorly, beneath the medial malleolus
- Posteriorly, ascend slightly to pass transversely over the tendo Achilles, at the level of the tibiotalar joint
- this incision differs from the calcaneus U-approach slightly because the upward deflection improves exposure of the tendo Achilles and tibiotalar joint
- Laterally, curve gently over the lateral malleolus
- End the incision anterolaterally just distal to the sinus tarsi
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| Dangers |
- 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
- Medial calcaneal nerve (medial)
- Nerve to abductor digiti minimi (medial)
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