Approach to Medial Side of Ankle

Chevron medial malleolar osteotomy with the deltoid ligament left attached, so that the malleolar fragment can be turned down distally to ex
Chevron medial malleolar osteotomy with the deltoid ligament left attached, so that the malleolar fragment can be turned down distally to expose the talar dome. Image from Yoshikawa Y, Oshiro H, Miyashi Y, Tome Y, Nishida K. Curettage and Artificial Bone Graft Using Chevron Osteotomy for Bone Tumor of the Talus, A Report of Three Cases. Cureus. 2025, 17(9), e92490. CC BY 4.0.
Gray’s Anatomy illustration of the tendon sheaths on the medial ankle
Synovial sheaths of the tendons around the ankle from the medial side. Tibialis posterior, flexor digitorum longus and the neurovascular bundle lie behind the medial malleolus. Image by Henry Vandyke Carter, Gray’s Anatomy (1918), Wikimedia Commons, public domain.

Position

  • supine
  • tourniquet
  • prep & drape

Landmarks

  • medial malleolus

Incision

  • 10 cm curved longitudinal incision centred over the tip of the medial malleolus

Internervous Plane

  • None
    • Dissection straight down to bone

Superficial Dissection

  • Mobilise the skin flaps

Deep Dissection

  • Osteotomy
    • Identify the point at which the MM joins the shaft of tibia
    • Small longitudinal incision in anterior part of joint capsule
    • Divide the flexor retinaculum
    • Identify the tendon of tibialis posterior & retract it posterior to expose the posterior surface of malleolus
    • Score longitudinally to ensure correct alignment of malleolus during closure
      • Pre-Drill & tap
    • Osteotome & oscillating saw
      • Cut through medial malleolus obliquely from top to bottom
      • Checking the position via the anterior arthrotomy
  • Retract medial malleolus with attached deltoid ligament downwards
  • Forcibly evert the foot exposing the dome of talus & articulating joint surface of tibia

Dangers

  • Nerves
    • Saphenous nerve
  • Vessels
  • Tendon of tibialis posterior

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