Operative technique

Patients were placed in the lateral decubitus position on a beanbag, with the foot to be operated on facing upward. We applied a thigh tourniquet, which was inflated to 300 mmHg. We used the standard extensile lateral approach to the calcaneus. An incision was made on the vertical limb just anterior to the Achilles tendon, allowing the sural nerve to be protected within the full-thickness flap. We took care not to injure the sural nerve at the distal end of the incision. Three 1.6-mm Kirschner wires were inserted into the lateral malleoli, talar neck, and the cuboid to protect the peroneal tendons and the full-thickness flap. We performed a lateral wall bumpectomy if impingement syndrome was present in the subfibular area. A downward oblique osteotomy was started from the calcaneal lateral wall and proceeded to the medial calcaneal wall. Two temporary pin fixations on the calcaneal lateral wall and the tuberosity fragment were slid downward using a compressor (Fig. 2). Finally, we fixed the osteotomy site in the correct position with two 6.5 mm cannulated screws and staples (Fig. 3).

a. A standard extensile lateral approach is marked on the calcaneus. b. A lateral bumpectomy is carried out. c. A downward oblique osteotomy is done on the calcaneal lateral wall. d. Two temporary pin fixations are fixed on the calcaneal lateral wall and the tuberosity fragment is slid downward using a compressor

The osteotomy site is fixed with two 6.5 mm cannulated screws