Ollier approach to the sinus tarsi

Introduction

The Ollier approach is an excellent choice for a triple arthrodesis, as it allows access to the three joints through a small opening without the need for extensive retraction. Wound healing is typically good because the proximal flap is created as a full-thickness layer, and the skin edges are protected during retraction.

Patient Positioning

The patient is placed in a supine position with a bump under the ipsilateral buttock.

Landmarks and Incision

• Make a curved incision, 8–10 cm in length.
• Begin the incision over the dorsal-lateral aspect of the talonavicular joint.
• Extend the incision posteriorly across the sinus tarsi (the soft-tissue depression just anterior to the lateral malleolus).
• Continue the incision obliquely to a point 2.5 cm below the tip of the lateral malleolus.

Internervous Plane

The internervous plane for the Ollier approach lies between:

• Peroneus tertius muscle: innervated by the deep peroneal nerve.
• Peroneus brevis muscle: innervated by the superficial peroneal nerve.

Superficial Dissection

• Incise the fascia and divide the inferior extensor retinaculum along the line of the incision.
• Ligate any veins crossing the surgical field.
• Mobilize small skin flaps (large flaps may necrose).
• Incise the deep fascia and extensor retinaculum in line with the skin incision. Take care to avoid damaging the peroneus tertius and extensor digitorum longus muscles.
• In the upper (distal) part of the incision, expose the peroneus tertius and extensor digitorum longus and retract them medially.
• In the lower part of the incision, expose the peroneal tendons and retract them inferiorly.

Deep Dissection

• Partially resect the fat pad overlying the sinus tarsi using sharp dissection (leave it attached to the skin flap).
• Identify and release the origin of the extensor digitorum brevis muscle beneath the fat pad.
• Retract the extensor digitorum brevis muscle distally.
• Identify and incise the dorsal capsule of the talocalcaneonavicular joint.
• Identify and incise the capsule of the calcaneocuboid joint.
• Incise the peroneal retinacula and retract the peroneal tendons anteriorly.
• Identify and incise the capsule of the posterior talocalcaneal joint.

Dangers

Structures at risk during the Ollier approach include:

1. Skin flap necrosis: Keep flaps small and full-thickness, and avoid sharp curves.
2. Tendon of the extensor digitorum longus muscle.
3. Peroneus brevis tendon.

References & More

• Campbell’s Operative Orthopaedics, 12th edition.
• Ollier’s lateral approach to the hindfoot – Orthobullets
• Meng Q, Wang Q, Wu X, Peng A, Yan J. Clinical application of the sinus tarsi approach in the treatment of intra-articular calcaneal fractures. Medicine (Baltimore). 2018 Mar;97(13):e0175. doi: 10.1097/MD.0000000000010175. PMID: 29595648; PMCID: PMC5895366. Pubmed