Updated: 8/13/2019

Extensile Lateral Approach to Calcaneus

Review Topic
  • Extensile Lateral ApproachAllows visualization of the lateral calcaneus and subtalar joint
  • Indications
    • calcaneus fractures
    • calcanectomy
  • No true internervous or intermuscular plane
Position & Preparation
  • Anesthesia
    • general anesthesia with endotracheal tube
  • Preparation
    • radiolucent table 
    • C-arm fluoroscopy
    • tourniquet can be used
  • Position
    • lateral decubitus positioning is necessary
    • slightly flex knee to relax gastrocnemius  muscle pull
  • Incision 
  • Superficial dissection 
    • place the posterior arm of the incision midway between the fibula and the Achilles tendon
    • place the horizontal arm in line with the base of the fifth metatarsal
    • proximal and distal ends of the incision are bluntly spread through until sural nerve is identified
    • full thickness fasciocutaneous flaps are sharply created over calcaneus
    • must not bevel the full-thickness aspect of the incision
    • the vascular supply to the flap is a  watershed area.
  • Deep dissection 
    • at the corner of the incision, make the incision directly to the bone to ensure that a full thickness flap is created.
      • avoid any undermining of the edges
    • a thick subperiosteal flap is sharply raised off of the lateral wall of the calcaneus until the sinus tarsi, neck, and posterior facet are visualized
    • 1.6mm K-wires can be placed into the talus, fibula, and cuboid 
      • the wires are then bent, allowing a "hands-free" retraction technique 
    • the peroneal tendons are subperiosteally elevated and reflected in anterior flap
    • calcaneofibular ligament is sharply released from the calcaneus
  • Approach extension
    • can extend proximally to a lateral approach to ankle/fibula  if needed
    • distal extension limited by sural nerve


  • Peroneal tendons
    • risk is minimized with maintenance of access under the anterior flap
    • must evaluate upon closure for instability or laceration(s)
  • Sural nerve  
    • risk is minimized with maintenance of access under the anterior flap
    • must dissect out proximal aspect of vertical limb and anterior aspect of horizontal limb to minimize iatrogenic injury 
  • Wound dehiscence
    • most common complication of this approach
    • lateral calcaneal artery is responsible for corner of flap
    • careful attention to skin handling and closure with Allgower-Donati suture technique minimizes soft tissue complications 

Please rate topic.

Average 4.5 of 13 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?
Questions (2)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Topic COMMENTS (6)
Private Note