Lateral Approach to Hindfoot (Ollier’s)

Indications

• Exposure to
  • Subtalar
  • Calcaneocuboid joints
  • Talonavicular
  • Triple arthrodesis

Position

• supine on operating table
• large sandbag under buttock to internally rotate the bag
• elevate & inflate tornique

Landmarks

• lateral malleolus
• lateral wall of calcaneus
• sinus tarsi
  • just anterior to lateral malleolus

Incision

• curved incision
• Start:
  • just distal to the distal end of lateral malleolus
• Continued over the lateral border of the foot & sinus tarsi
• End:
  • curving medially & ending over the talonavicular joint

Internervous Plane

• Peroneus tertius
  • Deep peroneal nerve
• Peroneal tendon
  • Superficial peroneal nerve

Superficial Dissection

• Incise down to fascia without developing skin flaps
• Ligate any veins that cross the operative field
• Open the deep fascia in line with skin incision
• Taking care not to damage
  • Tendons of
    • Peroneus tertius
    • Extensor digitorum longus
• Retract these tendons medially to gain access to the dorsum of the foot

Deep Dissection

• Reflect distally the fat pad overlying the sinus tarsi by sharp dissection leaving it attached to the skin flap
• Detach the origin of FDB which lies underneath to expose the capsule of TN & CC joints
• Perform capsulotomy to expose these joints

• Incise peroneal retinacula & reflect the tendons anteriorly
• Expose the capsule of the subtalar joint which I would incise

Dangers

• Skin Flaps
  • thick
• Nerves
• Vessels