Step-cut medial malleolar osteotomy: literature review and case reports

Talar dome pathology involving the medial half of the talus is a common occurrence. Direct visualization of this region of the ankle joint can be challenging because of anatomical constraints. Many lesions can be seen arthroscopically and, with the aid of a distractor, can be successfully treated. However, because of adhesive capsulitis and/or the size and location of the lesion, an open arthrotomy or a transmedial malleolar osteotomy may be required. The purpose of this article is to review the literature on techniques developed for gaining access to this area of the ankle and to highlight the step-cut medial malleolar osteotomy (SCMMO) and modifications that can be made to it to facilitate joint access. Two case studies are used to exemplify the SCMMO and modifications used to increase talar dome access. Because of anatomic constraints, many foot and ankle surgeons recommend osteotomy of the medial malleolus to gain access to the posteromedial aspect of the ankle. The step-cut approach is technically simple to perform; it can be safely modified when treating central lesions, it has inherent osseous stability that minimizes risk of displacement during rehabilitation, and it has a broad cancellous surface area, which facilitates osseous union. The authors recommend this procedure when an osteotomy is needed to gain access to the posteromedial ankle joint.