Medial approach to the calcaneus

July 18, 2026
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The medial approach to the calcaneus is primarily used for open reduction and internal fixation of calcaneal fractures.

Patient Positioning

  • The medial approach to the calcaneus can be performed with the patient supine, the knee bent, and the foot crossed over the opposite leg.
  • However, it is most easily performed with the patient in the prone position.

Landmarks and Incision

  • Begin 2.5 cm anterior and 4 cm distal to the medial malleolus.
  • Carry the incision posteriorly along the medial surface of the foot.
  • To expose the sustentaculum, the incision should be 5 cm long and follow the neurovascular structures.
  • Identify the posterior tibial tendon, the neurovascular bundle, and the flexor hallucis longus tendon.

Superficial Dissection

  • Develop the plane between the neurovascular bundle and the flexor hallucis longus tendon.
  • Incise the retinaculum. Palpate the prominence of the sustentaculum; it lies immediately above the flexor hallucis longus tendon.

Deep Dissection

  • Divide fat and fascia to define the inferior border of the abductor hallucis muscle.
  • Define the inferior border of the abductor hallucis muscle.
  • Mobilize the muscle belly and retract it dorsally. This exposes the medial and inferomedial aspects of the calcaneal body.
  • Continue the dissection distally by dividing the plantar aponeurosis and the muscles attached to the calcaneus.
  • Elevate the muscles and plantar aponeurosis subperiosteally from the medial and inferior calcaneus.

Dangers

Structures at risk during the medial approach to the calcaneus include:

  1. Medial calcaneal nerve.
  2. Nerve to the abductor digiti minimi muscle.

References

  • Campbell’s Operative Orthopaedics, 12th edition.

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