Lateral Approach to Hindpart of foot

Indications

  • excellent exposure of
    • talocaneonavicular
    • posterior talocalcaneal
    • calcaneocuboid joints
  • arthrodesis
    • including triple arthrodesis

Position

  • supine
  • sandbag
  • exsanguination
  • tourniquet

Landmarks

  • lateral malleolus
  • lateral wall of calcaneus
  • sinus tarsi

Incision

  • curved incision
  • Start: just distal to distal end of lateral malleolus
  • Over sinus tarsi, curving medially
  • End: talocalcaneonavicular

Internervous Plane

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

Superficial Dissection

  • Do not mobilize skin flaps
  • Ligate veins
  • Open deep fascia in line with skin incision
    • Beware
      • Peroneus tertius
      • EDL
    • Retract these muscles medially

Deep Dissection

  • Detach fat pad from sinus tarsi
  • Detach EDB from calcaneus
  • Expose capsule of talocalcaneonavicular & calcaneocuboid joint
    • Open these joints as necessary
  • Incise peroneal retinacula
    • Reflect peroneal tendons anteriorly
    • Incise capsule of posterior talocalcaneal joint

Dangers

  • Skin flap NECROSIS ++

Extensile

  • Proximally
    • Curve long the posterior border of fibula
    • Develop plane between peroneal muscles & flexor muscles