Lateral Approach to Subtalar Joint

Sinus tarsi approach to the calcaneus, showing the skin marking below the lateral malleolus, exposure of the fracture and reduction and plat
Sinus tarsi approach to the calcaneus, showing the skin marking below the lateral malleolus, exposure of the fracture and reduction and plate fixation through the same small incision. Image from Guven S, Bingol I, Demir C, Oktem U, Erdogan Y, Nazligul AS. Sinus Tarsi Versus Extensile Lateral Approach for Sanders Type II-IV Calcaneal Fractures, A Comparative Analysis of Functional Outcomes, Return to Work, and Cosmetic Parameters. J Clin Med. 2026, 15(9), 3420. CC BY 4.0.
Lateral Approach to Subtalar Joint, anatomy of the subtalar joint
Anatomy of the subtalar joint. Image by , Wikimedia Commons, CC BY-SA 3.0.

Indications

Position

  • supine
  • sandbag under buttock to bring lateral malleolus forward
  • lateral support on opposite iliac crest
  • tilt table 20°

Landmarks

  • Lateral malleolus
  • Achilles tendon

Incision

  • 15cm Curved L shaped incision over the lateral aspect of the ankle
  • Start
    • vertical limb is centred midway between the posterior border of the fibula & anterior border of the achilles tendon
  • horizontal limb is centred at the intersection with the thick smooth skin on the sole of the foot & the wrinkly skin on the dorsum of the foot

Internervous Plane

  • No internervous plane
    • As it reflects both peroneal tendons anteriorly

Superficial Dissection

  • Continue my incision straight down to bone achieving thick skin flaps
  • Being careful not to damage
  • Incise the inferior peroneal retinacula
  • Mobilise the peroneal tendons & reflect anteriorly

Deep Dissection

Dangers

  • Skin
  • Nerves
    • Sural nerve
  • Vessels
    • nil

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