Medial Approach to the Ankle Joint

Medial incision centred over the medial malleolus, running from 1 cm below its tip to about 8 to 10 cm above the ankle joint, with the malle
Medial incision centred over the medial malleolus, running from 1 cm below its tip to about 8 to 10 cm above the ankle joint, with the malleolar fragment reflected to expose the joint. Image from Yang K, Shen G, Zheng Q, Yang H, Zhang H, Li X, Tan Y, Zhu Y. Medial malleolar window approach for varus-type tibial pilon fractures, a retrospective study. BMC Musculoskelet Disord. 2023, 24(1), 358. CC BY 4.0.

Aims

Indications

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.
  • arthrodesis
  • excision of osteochondral fragments from medial side of talus
  • r/o loose bodies

Position

  • supine
  • partial exsanguination

Landmarks

  • medial malleolus

Incision

  • 10 cm longitudinal incision
  • Centred over tip of medial malleolus
  • Start: medial surface of tibia
  • End: medial cuneiform

Internervous Plane

  • None

Superficial Dissection

Deep Dissection

  • Divide flexor retinaculum
    • Retract Tib Post posteriorly
  • Medial Malleolar osteotomy
    • Score M.M. longitudinally to ensure correct alignment during closure
    • Drill & tap medial malleolus so that it can be reattached
  • Incise anteromedial ankle joint to help identify anterolateral junction of distal tibia
  • Oscillating saw
    • Cut through MM obliquely from top to bottom
    • Retract MM with deltoid ligament inferiorly
  • Evert foot to expose talar dome

Dangers

  • Nerves
    • Saphenous
  • Veins
    • Long saphenous vein
  • Tendon
    • Tibialis posterior

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