Anteromedial approach to the talus

The anteromedial approach is usually employed in combination with the anterolateral approach to obtain an anatomic reduction of displaced and comminuted fractures.

This anteromedial approach allows for direct visualization of medial fracture reduction and for the insertion of a medially based fixation construct.

If a medial malleolar osteotomy is planned, the incision needs to be more inferior proximally.

Illustration of anteromedial approach to the talus

This illustration shows the areas of the talus that are visualized through this surgical approach.

Talus regions visible through the anteromedial surgical approach

Blood supply to the talus

Note: Ensure not to damage the blood supply to the talus.

Note: Fracture dislocations can easily compromise the blood supply to the body of the talus and lead to avascular necrosis.

The blood supply to the talar body is complex.

These illustrations show the main arteries in the hindfoot and ankle.

$Talar blood supply with major hindfoot and ankle arteries at risk in fractures anterolateral approach$

Anterior view with main arteries

Anterior view of the foot and ankle with main arteries anterolateral approach

The talar neck receives arterial branches from the medial and lateral side (anterior and posterior tibial artery). The body of the talus is supplied almost exclusively from its posteromedial aspect.

The deltoid branches are important to supply blood to the medial talar neck and talar body. Branches from the dorsalis pedis supply the talar head and most of the dorsal talar neck.

The artery of the tarsal canal coming from branches off the posterior tibial artery supplies most of the talar body.

The peroneal artery has the least contribution laterally.

Artery of the tarsal canal supplying talar body and minimal lateral contribution from peroneal artery

Illustration showing the contribution of arterial blood supply to the talus:

Anterior tibial artery (blue)
Posterior tibial artery (orange) including the deltoid branch
Perforating peroneal artery (green)

Talar arterial blood supply from anterior, posterior tibial, and perforating peroneal arteries

Perform an incision starting at the medial malleolus and extending distally to the navicular.

For more complex fractures, particularly those requiring a medial malleolar osteotomy, the incision may be extended proximally.

The precise position and length of the incision depend on the fracture configuration and patient anatomy.

Anteromedial approach incision line from medial malleolus extending distally to the navicular

Preoperative marking of the incision

Anteromedial approach preoperative marking of the anteromedial incision

After incising through skin, identify the long saphenous vein and nerve. The vein and its branches may need to be ligated or coagulated.

Be careful not to damage the deltoid arterial branches which arise posteromedially and supply the medial two thirds of the talar body.

Minimize periosteal stripping of the talus to avoid damage to the blood supply.

Anteromedial approach dissection showing saphenous vein and nerve near incision

Once skin is incised and the medial talus identified, evacuate the fracture hematoma to expose the underlying inferomedial aspect of the neck and the fracture.

The arrow points to a simple fracture of the talar neck.

$Anteromedial approach exposed inferomedial talar neck fracture after hematoma evacuation$