Lateral approach to the hindpart of the foot (Ollier’s)

Indications

  • Exposure to
    • Subtalar
    • Calcaneocuboid joints
    • Talonavicular
    • Triple arthrodesis

Position

  • supine on operating table
  • large sandbag under buttock to internally rotate the bag
  • elevate & inflate tornique

Landmarks

  • lateral malleolus
  • lateral wall of calcaneus
  • sinus tarsi
    • just anterior to lateral malleolus

Incision

  • curved incision
  • Start:
    • just distal to the distal end of lateral malleolus
  • Continued over the lateral border of the foot & sinus tarsi
  • End:
    • curving medially & ending over the talonavicular joint

Internervous Plane

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

Superficial Dissection

  • Incise down to fascia without developing skin flaps
  • Ligate any veins that cross the operative field
  • Open the deep fascia in line with skin incision
  • Taking care not to damage
    • Tendons of
      • Peroneus tertius
      • Extensor digitorum longus
  • Retract these tendons medially to gain access to the dorsum of the foot

Deep Dissection

  • Reflect distally the fat pad overlying the sinus tarsi by sharp dissection leaving it attached to the skin flap
  • Detach the origin of FDB which lies underneath to expose the capsule of TN & CC joints
  • Perform capsulotomy to expose these joints
  • Incise peroneal retinacula & reflect the tendons anteriorly
  • Expose the capsule of the subtalar joint which I would incise

Dangers

  • Skin Flaps
    • thick
  • Nerves
  • Vessels
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