Authors of section


Khairul Faizi Mohammad, Brad Yoo

Executive Editors

Markku T Nousiainen, Richard Buckley

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Medial utility incision to the midfoot

1. Indications

The following structures can be accessed through this approach.

  • Whole medial aspect of the first metatarsal
  • Medial cuneiform
  • Medial aspect of the navicular
  • Head of the talus

Most often, only a portion of the overall length of this approach is used.

Structures accessed through medial utility incision to the navicular

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.

83_84_85 A040 Medial utility incision to the navicular and cuneiform

2. Anatomy

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.

Anatomical structures encountered in a medial utility incision to the navicular

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.

Skin incision for a medial utility incision to the navicular
Medial utility incision to the navicular

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.

Additional dorsomedial incision to the medial utility incision to the navicular

5. Closing the dead space

The medial utility incision can be closed in layers.

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