Place the patient supine on the operating table with a sandbag under the buttock of the opposite limb (see Fig. 3-1). The sandbag rotates the operative limb externally, causing the medial side of the foot to face the ceiling. Exsanguinate the limb, then apply a tourniquet to the mid-thigh.

Palpate the subcutaneous surface of the medial side of the calcaneus inferiorly and the medial malleolus superiorly. The neurovascular bundle runs down behind the medial malleolus. The medial tubercle of the calcaneus lies at the inferior border of the proximal end of the calcaneus, and cannot be felt as a discrete lump.

Make a 2-cm longitudinal incision in line with the long axis of the foot directly over the subcutaneous medial border of the calcaneus. Begin approximately 4 cm below and 2 cm posterior to the tip of the medial malleolus. The incision is over the medial tubercle of the calcaneus, where the origin of the plantar fascia lies (Fig. 22-1). The incision should be small and flaps should be full thickness.