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Medial approach to the calcaneus


The medial approach uses the medial malleolus and the navicular as landmarks. By drawing a perpendicular line down from the medial malleolus and by drawing a line proximal from the navicular, they meet at the sustentaculum tali. The incision follows the neurovascular bundle from just behind the medial malleolus to almost the navicular. Once the skin incision is made, the neurovascular structures are evident. The interval which one develops is between the posterior tibial nerve and the flexor hallucis longus tendon. The sustentaculum is a sharp bony prominence which is easy to find distal to the medial malleolus.
Dissection deep to the flexor hallucis reveals the sustentaculum tali and the medial wall of the calcaneus.