Weinstein Lovell and Winters Pediatric Orthopaedics 7e

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CHAPTER 30  |  The Child with a Limb Deficiency

FIGURE 30-13.  The dissection is completed with subperiosteal removal of the calcaneus. Using both a scalpel and peri- osteal elevator, the dissection is started posteriorly from within the ankle joint. Here again, the surgeon must be careful not to separate the calcaneal apophysis from the calcaneus. As soon as the Achilles tendon is identified, it should be exposed and a portion of it removed. This eliminates the tendency of the gastrocnemius muscle to pull the heel pad off the tibia, a common complication. After dividing the Achilles tendon, the dissection of the calcaneus proceeds around to the plantar surface. In some congenital anomalies, however, in which the heel is behind the tibia, it will be much easier to start dis- secting the calcaneus from the distal to the proximal side.