Anterolateral approach to the ankle through a slightly curved incision between the tibia and fibula, with the superficial peroneal nerve identified in the superficial layer (arrow) and the joint capsule opened to show the fracture. Image from Hseinat L, Al-Bataineh M, Abuain HA, Abu Zaid O, Abu Jalboush M, Al Omari Y, Al-Jarajreh S, Tawalbeh A. Isolated Displaced Chaput Fracture (Rammelt Type III) With Significant Intra-articular Displacement, A Case Report. Cureus. 2026, 18(8), e114421. CC BY 4.0.

The anterolateral approach to the ankle and hindfoot uses the plane between the extensor tendons and the peroneal tendons to expose the ankle, talonavicular, calcaneocuboid and subtalar joints. It is used for ankle, triple and pantalar arthrodesis, protecting the superficial peroneal nerve.

Gray’s Anatomy illustration of the lateral ligaments of the foot — Ligaments of the foot from the lateral side, showing the ankle, subtalar and midfoot joints reached through the anterolateral approach. Image by Henry Vandyke Carter, Gray’s Anatomy (1918), Wikimedia Commons, public domain.

Aims

Plane between extensors & peroneal

Indications

Exposure of
- Ankle joint
- TN joint
- CC joint
- TC joint
Arthrodesis
- Ankle
- Triple
- Pantalar
Reduction talus or excision

Position

supine
large sandbag under buttock
tourniquet
prep & drape

Landmarks

Lateral malleolus
Base of 5th metatarsal

Incision

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

Internervous Plane

Peroneal muscles
- Superficial peroneal nerves
Extensor muscles
- Deep peroneal nerves

Superficial Dissection

Incise fascia (no skin flaps)
- Taking care to identify & preserve
  - Dorsal cutaneous branches of superficial peroneal nerve
Incise superior & inferior extensor retinaculum
Identify peroneus tertius & EDL
- In upper half of wound
  - Incise down to bone just lateral to these muscles

Deep Dissection

Retract extensor muscles medially to expose the anterior aspect of the distal tibia & ankle joint capsule
Distally
- Identify EDB at origin from calcaneus
- Detach by sharp dissection
- Cauterise branches of lateral tarsal artery to prevent haematoma formation
- Reflect EDB distally & medially
Identify the capsules of CC & TN joints
Identify the fat in the sinus tarsi (laterally)
- Reflect it distally to expose the subtalar joint

Dangers

Nerves
- Deep peroneal nerve
Vessels
- Anterior tibial artery

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