Challenge of the Week / Foot & Ankle / 02.05.2021

Which of the following anatomic structures is most at risk while performing a direct medial approach for a Lapidus bunion correction?
    • Posterior tibial tendon
    • The posterior tibial tendon inserts broadly but primarily on the medial navicular. It is well proximal to the site in question


    • Dorsalis pedis (DP) artery
    • The DP artery is lateral to the 1st tarsometatarsal joint


    • Flexor hallucis longus (FHL)
    • The FHL is relatively plantar as compared to this medial approach


    • Anterior tibial tendon
    • The anterior tibial tendon inserts dorsomedially on the medial cuneiform and the 1st metatarsal base (the bones involved in a a Lapidus procedure). It is at risk with a direct medial approach


    • Dorsal medial hallucal cutaneous nerve
    • The dorsal hallucal cutaneous nerve is at risk, but the risk is greater to the anterior tibial tendon with a direct medial approach to the 1st tarsometatarsal joint



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