Dorsoplantar Approach to the Calcaneus

Abstract

The dorsoplantar approach to the calcaneus combines the possibility of wide exposure with a minimal risk of nervous or vascular disturbance. It makes use of an interneural plane between saphenous and sural nerve and an intervascular plane between tibial and peroneal artery and their concomitant veins (Fig. 1). The line of incision follows the lateral border of the Achilles tendon, crosses the midline of the heel, and runs through the sole of the foot to the tubercle of the fifth metatarsal. All nerves and vessels crossing this line are only part of a network with multiple anastomoses. No harm is to be expected when any of them are severed. It is essential, that the cut goes right down to the bone, the plantar aponeurosis, and the short plantar muscles. If one starts isolating layers of tissue, the vascularity of the overlying skin is at risk.