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Increased Lateral Calcaneal Body and Subtalar Joint Visualization Utilizing a Modified Sinus Tarsi Approach.

Rohan Bhimani1,2, Andrew M Hresko1,2,3, Kevin Y Wang1,2,3

  • 1Department of Orthopaedic Surgery, Division of Foot and Ankle Surgery, Massachusetts General Hospital, Boston, MA, USA.

Foot & Ankle International
|June 25, 2025
PubMed
Summary

The modified sinus tarsi approach (MST) significantly increases calcaneal surface visualization compared to the traditional sinus tarsi approach (TST). This enhanced exposure may improve fracture reduction and fixation, but careful attention to the sural nerve is necessary.

Keywords:
calcaneal fracturescalcaneusmodified sinus tarsisinus tarsi approachsubtalar joint

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Area of Science:

  • Orthopedic Surgery
  • Anatomy
  • Surgical Technique

Background:

  • The traditional sinus tarsi approach (TST) is favored for calcaneus fracture fixation due to adequate exposure and low complication rates.
  • However, TST visualization can be limited compared to more extensive surgical methods.
  • A modified sinus tarsi approach (MST) is proposed to enhance exposure by extending the TST incision.

Purpose of the Study:

  • To quantitatively compare the surgical exposure provided by the traditional sinus tarsi approach (TST) and the modified sinus tarsi approach (MST).
  • To assess the potential benefits of MST for calcaneus fracture treatment.

Main Methods:

  • Twelve cadaveric specimens were dissected sequentially using both TST and MST.
  • Exposed calcaneal areas (lateral wall, posterior facet, dorsal surface) were measured using digital imaging.
  • The proximity of the sural nerve to the MST incision was recorded.

Main Results:

  • The MST significantly increased the exposed surface area of the lateral calcaneal wall, posterior facet, and dorsal surface compared to the TST (P < .0001).
  • MST provided substantially greater coverage of these critical calcaneal areas.
  • The sural nerve was located very close to the distal extent of the MST incision on average.

Conclusions:

  • The modified sinus tarsi approach (MST) offers significantly enhanced visualization of calcaneal surfaces compared to the traditional sinus tarsi approach (TST).
  • This improved exposure may lead to better outcomes in calcaneus fracture reduction and fixation.
  • Caution is advised regarding the sural nerve's proximity to the MST incision.