Ankle – Posteromedial Approach

Ankle – posteromedial approach

* position
– supine with hip flexed & ER and knee flexed
– lateral with affected leg down

* incision – long. incision midway btw Achilles tendon & med. malleolus

* no internervous plane

* dissection
– deepen incision to enter fat that lies btw Achilles & flexor tendons
– ID fascia in ant. flap that covers flexor tendons

> first
– ID FHL
– develop plane btw FHL & peroneal tendons
– expose ankle joint & incise capsule

> second
– ID FHL
– continue dissection ant. toward med. malleolus
– ID nv bundle & retract lat. with FHL
– develop plane btw nv bundle & FDL
– expose ankle & incise capsule

* dangers
– PTA & tibial n. – run btw FDL & FHL with art. ant. to nerve