Lateral Approach to the Os Peroneum

This approach is used primarily for resection of the base of the fifth metatarsal or for removal of the os peroneum. The peroneal tendons can also be seen with this incision. An accurate assessment of the patient’s vascular status is critical before considering surgery owing to the fact that diseases such as diabetes and vasculopathies (associated neuropathies and smoking) are relative contraindications to extensive surgical approaches to the foot.

Position of the Patient

Place the patient in the lateral position on the operating table (see Fig. 19-1). Ensure that all bony prominences are well padded. Place the leg that is to be operated on posteriorly, with the under leg anterior. Exsanguinate the limb either by elevating it for a few minutes or by applying a soft rubber bandage. Inflate a tourniquet on the mid-thigh.

Landmarks and Incision

Palpate the posterior border of the distal fibula and the lateral border of the Achilles tendon. Next, identify the styloid process at the base of the fifth metatarsal bone, which is easily felt along the lateral aspect of the foot. Make a 3- to 4-cm longitudinal incision on the lateral aspect of the foot. Begin the incision at the base of the fifth metatarsal and extend it posteriorly, following the junction between the smooth skin of the dorsum of the foot and the wrinkled skin of the sole (Fig. 21-1). The exact length of the incision is determined by the pathology to be treated.

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