Posteromedial Approach to the AnkleThe posteromedial approach to the ankle joint is routinely used for exploring the soft tissues that run around the back of the medial malleolus. This approach is used for the release of soft tissue around the medial malleolus in the treatment of clubfoot.
The approach can also be used to allow access to the posterior malleolus of the ankle joint, but gives limited exposure of the fracture site and is technically demanding. For this reason, reduction and fixation of posterior malleolar fractures is usually achieved by indirect techniques.1
Position of the Patient
Either of two positions is available for this approach. First, place the patient supine on the operating table. Flex the hip and knee, and place the lateral side of the affected ankle on the anterior surface of the opposite knee. This position will achieve full external rotation of the hip, permitting better exposure of the medial structures of the ankle (Fig. 5-1). Alternatively, place the patient in the lateral position with the affected leg nearest the table. Flex the knee of the opposite limb to get its ankle out of the way.
Exsanguinate the limb by elevating it for 3 to 5 minutes or applying a soft rubber bandage; then inflate a tourniquet.
Landmarks and Incision
Landmarks
The medial malleolus is the bulbous, distal, subcutaneous end of the tibia.
Palpate the Achilles tendon just above the calcaneus.
 Figure 5-1 Place the patient supine on the operating table with the knee and the hip flexed to expose the medial structures of the ankle. |
 Figure 5-2 Make an 8- to 10-cm longitudinal incision roughly between the medial malleolus and the Achilles tendon. |
Incision
Make an 8- to 10-cm longitudinal incision roughly midway between the medial malleolus and the Achilles tendon (Fig. 5-2).
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