· make a curved incision over the dorsolateral aspect of the foot
· from the talonavicular joint dorsally
· to 2.5 cm inferior to the lateral malleolus
· expose and protect the
· dorsolateral branch of the superficial peroneal nerve
· inferior extensor retinaculum
· lateral border of the peroneus tertius tendon
· incise the inferior retinaculum at right angles to its fibres
· at the lateral border of the peroneus tertius tendon
· detach the extensor digitorum brevis from its origin on the calcaneus
· diathermy the branches of the lateral tarsal artery
· open the lateral aspect of the talonavicular joint
· incise the capsule laterally
· incise the calcaneonavicular limb of the bifurcate ligament inferiorly
· open the calcaneocuboid joint
· incise the capsule dorsally and laterally
· incise the calcaneocuboid limb of the bifurcate ligament
· open the posterior facet of the subtalar joint
· release the deep projections of the inferior extensor retinaculum
· release the cervical ligament
· incise the anterior joint capsule of the posterior talocalcaneal joint
· open the joint and release the interosseous talocalcaneal ligament
· spread joint with laminar spreaders
· remove the anterior projection of the calcaneus
· helps expose the calcaneocuboid joint and sinus tarsi
· denude the calcaneocuboid joint of cartilage
· distract the subtalar joint and denude it of cartilage
· denude all three facets
· use curved and flexible osteotomes to remove cartilage
· preserve subchondral bone and shape of bony surfaces
· make a medial incision
· from 1 cm distal to medial malleolus
· to level of navicular-first cuneiform joint
· expose and protect the saphenous vein and nerve
· open the talonavicular joint dorsally, medially and inferiorly
· denude the joint of cartilage
· use curved and flexible osteotomes
· curved bony surfaces allow subtle adjustment of position
· correct position of foot
· insert 2 large K wires across the talonavicular and calcaneocuboid joints
· insert screw across subtalar joint
· from just posterior to lateral tubercle upwards forwards and medially
· if use cannulated screw, can insert guidewire first and check position
· check position of foot visually and obtain x-ray
· aim for
· valgus of calcaneus (5-7o)
· plantigrade foot
· cast for 12 weeks
· patient prone
· make an oblique incision
· from lateral border of tendo Achilles
· to inferior border of distal end of calcaneus
· protect the sural nerve
· do not enter the peroneal sheath
· expose the superior and inferior surfaces of the calcaneus
· use a drill to make several bicortical holes
· obliquely from 1 cm posterior to posterior talus
· to 1 cm distal to calcaneal tuberosity
· complete the osteotomy
· displace the posterior fragment medially
· 1/3 to 1/2 of width of calcaneus
· until medial border in line with sustentaculum tali
· hold osteotomy with cannulated screw
· cast for 6 weeks