Cutaneous sensory nerve injury during surgical approaches to the foot and ankle: A cadaveric anatomic study

Methods Skin incisions for eight of the most frequent approaches used in foot and ankle surgery were performed on 10 cadaveric feet. The cutaneous nerves of the foot and ankle were dissected and localized with reference to the incisions. Results None of the eight incisions were safe. Cutaneous sensory nerves were at greatest risk following the anteromedial approach to the ankle. The total number of transected nerves on the 10 feet ranged from 37 for the anteromedial approach to the ankle to 4 for the medial approach to the first metatarsophalangeal joint. Due to the wide anatomical variability of the nerves involved, universally safe regions for skin incisions cannot be expected. Conclusions/clinical relevance This study reveals that standard orthopaedic approaches to the foot and ankle are associated with a consistent risk of cutaneous nerve injury. We recommend that the individual nerve pattern of each patient be respected by meticulous operative technique.