Contents
- Introduction
- Indications
- Position of patient
- Landmarks and incision
- Internervous plane
- Superficial dissection
- Deep dissection
- Dangers
- How to enlarge the approach
- Figures
Introduction
- Allows exposure of the ankle joint, the talonavicular, calcaneocuboid, and talocalcaneal joints
Indications
- Ankle fusions
- Triple arthrodesis and pantalar arthrodesis
- Excision of the entire talus, or to reduce it in cases of talar dislocation
Position of patient
- Patient is placed supine on the operating table, with a sandbag underneath the affected buttock
Landmarks and incision
Landmark
- Palpate the lateral malleolus and the base of the 5th metatarsal
Incision
- Begin 5 cm proximal to the ankle joint, 2 cm anterior to the anterior border of the fibula
- 15-cm in length slightly curved on the anterolateral aspect of the ankle down
- Cross the ankle joint 2 cm medial to the tip of the lateral malleolus, and continue on the foot
- End some 2 cm medial to the 5th metatarsal base, over the base of the 4th metatarsal
Internervous plane
- Lies between the peroneal muscles (superficial peroneal nerve) and the extensor muscles (deep peroneal nerve)
Superficial dissection
- Incise the deep fascia with the superior and inferior retinaculum in line with the incision; preserves the superficial peroneal nerve
- Do not develop skin flaps
- Incise down to bone lateral to the peroneus tertius and the extensor digitorum longus muscles in the upper half of wound
Deep dissection
- Expose the anterior aspect of the distal tibia and the anterior ankle joint capsule by retracting the extensor musculature medially
- Identify the extensor digitorum brevis muscle distally and sharply detach it from its calcaneal origin while cauterizing branches of the lateral tarsal artery
- Reflect the detached extensor digitorum brevis muscle distally and medially, lifting the muscle fascia and the subcutaneous fat and skin as one flap
- Identify the dorsal capsules of the calcaneocuboid and talonavicular joints
- Mobilize the fat pad in the sinus tarsi either by turning it downward or by excising it to expose the talocalcaneal joint
- To open the joints, forcefully flex and invert the foot in a plantar direction after opening the joints capsule
Dangers
- Crossing the front of the ankle joint are the deep peroneal nerve and the anterior tibial artery
- Dissection is carried out as close to the bone as possible
How to enlarge the approach
Proximal
- Incise the thick deep fascia in line with the skin incision to explore structures in the anterior compartment of the leg
Distal
- Continue the incision over the fourth metatarsal to expose the subcutaneous tarsometatarsal joints on the lateral half of the foot
Figures
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