Posteromedial Approach to the Ankle

Indications

• club foot

Position

• Supine
• Exsanguinate
• Inflate tourniquet

Landmarks

• Medial malleolus
• Achilles tendon

Incision

• 10 cm longitudinal incision midway between medial malleolus & achilles tendon

Superficial Dissection

• deepen incision in fat inline with incision
  • between TA & structures behind MM
• If TA needs lengthening
  • Lengthen now
• Incise fascial plane that covers the other flexor tendons

Deep Dissection

• Identify FHL
  • (beef to heel)
• on its lateral border
  • develop plane between FHL & peroneal tendons
• Incise capsule

Dangers

• Posterior tibial artery
• Tibial nerve
  • In children, the nerve looks very similar to FDL tendon
• Distally
  • Curve it towards TN joint
  • Can expose master knot of Henry