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An Atkins procedure (namely a full thickness "L" incision on the lateral surface of the calcaneus with creation of a flap) should be preferred, not only because the neurologic structures, in particular the sural nerve, are protected along with Achilles tendon and the plantar fascia, (4) but also since it permits useful localization of the calcaneal insertion of the extensors retinaculum and talocalcaneal ligament (Fig.
The wire is maintained firmly tangent to the insertions ends of the extensors retinaculum and talocalcaneal ligament, checking its position under fluoroscopy (Fig.
Forces that can influence talocalcaneal joint are calcaneofibular ligament, the superior peroneal retinaculum (calcaneal fibular retinaculum), the peroneal tendon sheaths, and the posterior talocalcaneal ligament.
The strong talocalcaneal ligament stabilises the joint which is synovial with a single oblique axis that declines backward and laterally.
The lateral process of the talus is aided by the lateral talocalcaneal ligament that extends between it and the calcaneus.
The talocalcaneal ligament thus becomes taunt in supination and eventually becomes inflamed and painful under stress.
Gould and coworkers (45) further modified the Brostrom procedure by reinforcing the repair using the lateral talocalcaneal ligament, CFL, and inferior extensor retinaculum, which helped limit inversion and corrected subtalar instability (Fig.
The strong talocalcaneal ligament stabilizes the joint which is synovial with a single oblique axis that declines backward and laterally.
The lateral talocalcaneal ligament originates on the lateral wall of the calcaneus just anterior to the origin of the CFL and inserts onto the body of the talus just inferior to the ATFL.
Finally, the deep layer of the lateral ligamentous complex contains the medial root of the inferior extensor retinaculum, which courses more deeply in the sinus tarsi and sends attachments to both the talus and the calcaneus adjacent to the interosseous talocalcaneal ligament (IOL).
The lateral tubercle is larger and serves as the attachment site for the posterior talofibular and the posterior talocalcaneal ligaments.