Posteromedial Approach to the Ankle

Cross section of the distal leg showing the intervals used to reach the distal tibia, including the posteromedial corridor between the poste
Cross section of the distal leg showing the intervals used to reach the distal tibia, including the posteromedial corridor between the posterior tibial tendons and the tibial neurovascular bundle. Image from Liu J, Zhang Z, Qu J, Piao C. Progress of fracture mapping technology based on CT three-dimensional reconstruction. Front Bioeng Biotechnol. 2024, 12, 1471470. CC BY 4.0.
Posteromedial Approach to the Ankle, ligaments of the medial ankle and foot, gray’s anatomy plate 354
Ligaments of the medial ankle and foot, Gray’s Anatomy plate 354. Image by Henry Vandyke Carter, Wikimedia Commons, Public domain.

Indications

  • club foot

Position

  • Supine
  • Exsanguinate
  • Inflate tourniquet

Landmarks

  • Medial malleolus
  • Achilles tendon

Incision

  • 10 cm longitudinal incision midway between medial malleolus & achilles tendon

Superficial Dissection

  • deepen incision in fat inline with incision
    • between TA & structures behind MM
  • If TA needs lengthening
    • Lengthen now
  • Incise fascial plane that covers the other flexor tendons

Deep Dissection

  • Identify FHL
    • (beef to heel)
  • on its lateral border
    • develop plane between FHL & peroneal tendons
  • Incise capsule

Dangers

  • Posterior tibial artery
  • Tibial nerve
    • In children, the nerve looks very similar to FDL tendon
  • Distally
    • Curve it towards TN joint
    • Can expose master knot of Henry

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.