Lateral Approach to the Hindpart of the Foot

Diagram of the extensile lateral L shaped incision of the calcaneus, with a vertical limb anterior to the Achilles tendon and a horizontal l
Diagram of the extensile lateral L shaped incision of the calcaneus, with a vertical limb anterior to the Achilles tendon and a horizontal limb along the lateral border of the foot towards the base of the fifth metatarsal. Image from Ma Z, Chen J, Nan X, Li Y, Li D, Hou F. Observation on the efficacy of skin closure by skin staplers in extended L-shaped incisions for calcaneal fractures. J Orthop Surg Res. 2026, 21(1), 228. CC BY 4.0.
Lateral Approach to the Hindpart of the Foot, lateral surface of the calcaneus, gray’s anatomy plate 266
Lateral surface of the calcaneus, Gray’s Anatomy plate 266. Image by Henry Vandyke Carter, Wikimedia Commons, Public domain.

Indications

  • excellent exposure of
    • talocalcaneonavicular
    • posterior talocalcaneal
    • calcaneocuboid joints
  • arthrodesis
    • including triple arthrodesis

Position

  • supine
  • sandbag
  • exsanguination
  • tourniquet

Landmarks

  • lateral malleolus
  • lateral wall of calcaneus
  • sinus tarsi

Incision

  • curved incision
  • Start: just distal to distal end of lateral malleolus
  • Over sinus tarsi, curving medially
  • End: talocalcaneonavicular

Internervous Plane

Superficial Dissection

  • Do not mobilise skin flaps
  • Ligate veins
  • Open deep fascia in line with skin incision
    • Beware
      • Peroneus tertius
      • EDL
    • Retract these muscles medially

Deep Dissection

  • Detach fat pad from sinus tarsi
  • Detach EDB from calcaneus
  • Expose capsule of talocalcaneonavicular & calcaneocuboid joint
    • Open these joints as necessary
  • Incise peroneal retinacula
    • Reflect peroneal tendons anteriorly
    • Incise capsule of posterior talocalcaneal joint

Dangers

  • Skin flap NECROSIS ++

Extensile

  • Proximally
    • Curve along the posterior border of fibula
    • Develop plane between peroneal muscles & flexor muscles

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