The following structures can be accessed through this approach.
Whole medial aspect of the first metatarsal
Medial aspect of the navicular
Head of the talus
Most often, only a portion of the overall length of this approach is used.
Combination with other approaches
This approach may be combined with other approaches. In this case, it is crucial to keep a minimum of 5 cm distance between the two incisions to ensure the survival of the skin bridge.
The medial utility incision is performed in a safe plane between the posterior tibialis and the anterior tibialis. There are no major neurovascular structures in this region. Superficial small veins can be cauterized during the approach.
3. Skin incision
For the medial approach to the navicular, the area along the medial utility incision over the navicular is used. The incision can be extended proximally to allow access to the talonavicular joint or distally to access the cuneiforms, first metatarsal base, and naviculocuneiform and intertarsal joints. The incision should be full thickness with no undermining of tissues.
4. Additional dorsomedial incision
An additional dorsomedial incision can be used to aid the reduction of intraarticular fractures.
When dissecting the dorsomedial incision, soft tissue stripping should be kept to a minimum to prevent disruption of the blood supply to the navicular.
For details of the dorsomedial approach, click here.
5. Closing the dead space
The medial utility incision can be closed in layers.