HEEL ANATOMY FOR RETROGRADE TIBIOTALOCALCANEAL RODDINGS - A ROENTGENOGRAPHIC AND ANATOMIC ANALYSIS

There is an increased interest in load-sharing devices for tibiotaloca lcaneal arthrodesis. Although the neurovascular anatomy of the heel ha s been well described, the purpose of this study is to consider heel a natomy as it relates to plantar heel incisions and to well-defined flu oroscopic landmarks to prevent complications during these procedures. Twenty lateral radiographs of normal feet while standing were evaluate d by two observers. The distance from the calcaneocuboid (CC) joint to a line parallel to the center of the intramedullary canal of the tibi a was calculated. In the second part of the study, 14 dissections of t he arterial and neural anatomy were performed. The distances from the CC joint to structures crossing the heel proximal to the CC joint were studied. In the 20 standing radiographs, the mean distance from the C C joint to the middle of the intramedullary canal of the tibia was 2.1 cm (standard deviation, 0.55 cm). In the dissections, the only artery or nerve found to cross the plantar surface proximal to the CC joint was the nerve to the abductor digiti quinti (NAbDQ). The mean distance from the CC joint to the NAbDQ was 3.1 cm (standard deviation, 1.36 c m). Assuming reaming to 12 mm, NAbDQ would be at risk 42% of the time. We recommend careful dissection of the heel during retrograde rodding s to avoid damage to NAbDQ and subsequent neurogenic heel pain.