Open procedures

Surgical Procedure

Create a curved incision over the medial malleolus
Dissect towards the distal tibial
Dissect towards the anteromedial ankle joint
With the periosteal elevator, slide over the periostium in lateral direction
Place a Hohman retractor at the level just proximal of the joint line
Identify the posterior tibial tendon and incise the tendon sheet.
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Pearls & Pitfalls

Identify the intersection of the horizontal distal tibia and the vertical medial malleolus by means of a arthroscopic probe anterior and posterior.

Make the initial osteotomy by means of an oscillating saw. Don't finish it into the joint in order to avoid cartilage damage to the talus. Finish with an osteotome.