Updated: 5/29/2013

U Approach to Calcaneus

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Indications
  • Calcaneus fracture
Positioning
  • Place patient prone
  • Support leg on sandbag
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 
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 
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  
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
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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