Updated: 3/26/2013

Anterior Approach to Ankle and Tarsus

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https://upload.orthobullets.com/topic/12042/images/lateral ankle exposure 1a.jpg
https://upload.orthobullets.com/topic/12042/images/figure 2.jpg
Indications
  •  Provides exposure to
    • ankle joint
    • tarsal bones
    • subtalar joint
    • talonavicular joint and calcaneocuboid joint
    • cuboid-metatarsal joints
    • cuboid-cuneiform joints
Approach
  • Position
    • supine
    • can exanguinate leg if using tourniquet
  • Incision 
    • begin incision anteromedial to fibula 5 cm proximal to ankle joint
    • carry incision over ankle joint to base of fourth metatarsal
      • may be extended both proximally and distally
  • Superficial dissection
    • incise fascia, superior and inferior extensor retinacula down to periosteum of distal tibia and ankle joint capsule
    • identify and retract intermediate dorsal cutaneous branches of superficial peroneal nerve
    • retract extensor tendons, deep peroneal nerve, and dorsalis pedis artery medially
    • divide extensor digitorum brevis in direction of its fibers (or may detach proximal origin and reflect distally)
  •  Deep dissection
    • expose ankle joint capsule 
    • expose talonavicular joint and calcaneocuboid joint (same plane)
    • expose subtalar joint (must first remove lateral fat pad)
    • if needed: extend dissection distally to expose joint between cuboid and 4th and 5th metatarsals
    • if needed: extend dissection distally to expose joint between cuboid and third cuneiform
Dangers
  • Avoids most important vessels and nerves
 

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