Anterolateral approach to Ankle & Hindfoot of Foot

Indications

exposure to
- ankle joint
- talonavicular joint
- calcaneocuboid joint
- talocalcaneal joint
ankle fusions
triple arthrodesis
pantalar arthrodesis

Position

supine
sandbag under buttock
exansguinate
torniquet

Landmarks

lateral malleolus
base of 5th metatarsal

Incision

15 cm slightly curved incision on anterolateral aspect of ankle
Start: 5cm proximal to ankle joint, 2cm anterior to anterior border of fibula
End: 2cm medial to 5th metartarsal base (over base of 4th metatarsal)

Internervous Plane

Peroneal muscles
- Superficial peroneal nerve
Extensor muscles
- Deep peroneal nerve

Superficial Dissection

Incise fascia inline with skin incision
Cut through superior & inferior extensor retinaculum
Beware
- Dorsal cutaneous branches of superficial peroneal nerve
Identify peroneus tertius & EDL
- In upper half of wound, incise down to bone lateral to them

Deep Dissection

Retract extensor muscles medially

Exposes distal tibia & anterior ankle joint capsule

Detach EDB from calcaneal origin
Diathermy branches of lateral tarsal artery
Identify dorsal capsules of calcaneocuboid & talonavicular joints
Clear fat from sinus tarsi to expose talocalcaneal joint
Incise necessary capsules

Dangers

Deep peroneal nerve
Anterior tibial artery

Procedure

Proximally
- To expose anterior compartment of leg
Distally
- Tarsometatarsal joint on lateral half of foot