Medial and Lateral Approaches to Insertional Achilles Disease
Insertional Achilles disease offers a number of challenges for the surgeon. One of the areas of debate is the optimal surgical approach to deal with the varied pathology in this anatomic area.1, 2, 3, 4 The choice of approach is guided by the anatomic location of the pathology, the need to access non-Achilles structures, and surgeon preference. This chapter describes the medial and lateral approaches to the insertion, as well as the variants of each, based on the anatomy and pathology.
The normal anatomy of the Achilles insertion is unique primarily as to the area of the insertion and the bony anatomy that juxtaposes the tendon. The gastrocnemius and soleus tendons blend together to form a single tendon in the distal posterior calf. The combined tendon (Achilles) rotates internally, placing the soleus fibers more medial and posterior to those of the gastrocnemius. The broad insertion on the flattened surface of the posterior calcaneus completely covers the middle third of this...
KeywordsSural Nerve Medial Approach Posterior Tibial Nerve Flexor Hallucis Longus Subperiosteal Dissection
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