Updated: 9/21/2015

Medial Approach to Calcaneus

Topic
Review Topic
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Indications
  • Calcaneus fractures
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
  • 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
  • Medial calcaneal nerve
  • Nerve to abductor digiti minimi
 

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