Updated: 5/29/2013

U Approach to Calcaneus

Review Topic
  • Calcaneus fracture
  • Place patient prone
  • Support leg on sandbag
  • 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 
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  
Cincinnatti Incision 
  • 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  
  • 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
  • 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)

Please rate topic.

Average 5.0 of 1 Ratings

Thank you for rating! Please vote below and help us build the most advanced adaptive learning platform in medicine

The complexity of this topic is appropriate for?
How important is this topic for board examinations?
How important is this topic for clinical practice?
Topic COMMENTS (1)
Private Note