How to Perform Surgery on the Hindpart of the Foot: An Anatomical Guide by Dr. Mohammad Hutaif
Discover the surgical anatomy of the three joints of the hindpart of the foot and how to treat osteomyelitis in children with this comprehensive guide by Dr. Mohammad Hutaif.
Author Dr.Mohammad Hutaif, Email
Surgery performed on the hindpart of the foot is confined almost exclusively to three joints: The posterior part of the subtalar joint, the talocalcaneonavicular joint, and the calcaneocuboid joint. The anatomy of the approaches is the anatomy of the joints themselves, because they all are superficial structures (see Figs. 12-63 and 12-66).
The key to the anatomy is the tarsal canal, which runs obliquely across the foot, between the talus and the calcaneus. The canal is formed by two grooves, one on the inferior surface of the talus and the other on the superior surface of the calcaneus. The canal separates the talocalcaneonavicular joint from the talocalcaneal joint and acts as a landmark for surgical access to the two joints. At its lateral end, the canal widens considerably into the sinus tarsi.
The sinus tarsi contains a tough ligament, the ligamentum cervicis tali, and a large fat pad; the ligament must be divided and the fat pad mobilized for access to the sinus and joints. The extensor digitorum brevis muscle originates from the top of the anterior wall of the sinus. It must be detached for access to the calcaneocuboid joint.
Behind the tarsal canal lies the posterior part of the subtalar joint, which consists of a convex superior facet of the talus and a concave facet of the talus. The joint line is oblique when viewed from the lateral (operative) side. To see it better, the peroneal tendons that overlie it partially must be mobilized and retracted anteriorly.
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Figure 12-64 Superficial anatomy of the posterolateral aspect of the foot and ankle. Note that the muscle fibers of the peroneus brevis run all the way to the ankle joint and lie immediately posterior to the lateral malleolus.
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Figure 12-65 The Achilles tendon and the peroneus muscles have been resected to reveal the posterolateral aspect of the ankle joint and the deep flexor tendons of the foot. The flexor hallucis longus is immediately medial to the peroneus brevis. The fascia investing these muscles is deep to the deep fascia; it separates them into peroneal and deep flexor compartments. The flexor hallucis longus remains muscular down to the ankle joint.
Distal to the tarsal canal lies the anterior part of the subtalar joint and the talocalcaneonavicular joint. This complex joint consists of a ball (the head of the talus) articulating with a socket (the concave posterior aspect of the navicular, the concave anterior end of the superior surface of the calcaneus, and the spring ligament—short plantar calcaneonavicular ligament—that connects the two bony elements of the socket). From the lateral side, the talonavicular part of the joint appears nearly vertical. From a dorsal point of view, the joint runs transversely across the foot, in line with the calcaneocuboid joint.
Distal to the sinus tarsi lies the calcaneocuboid joint, formed by the
anterior end of the calcaneus and the posterior aspect of the cuboid. From the lateral side, the joint looks vertical. A more dorsal view shows that it runs transversely across the foot in line with the talonavicular joint.
Once the sinus tarsi has been defined, all these joints become accessible if surgery remains on bone and the surgeon is aware of the different planes of the joints.
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Figure 12-66 Osteology of the posterolateral aspect of the foot and ankle.
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