Supine position

(Figures 92 and 93)

• Supine position on a standard operating table (may need to be radiolucent)

• Dorsomedial approaches. The leg naturally lies in slight external rotation when a patient is supine (see Figure 86). To increase external rotation, the figure-of-4 position may be used (see Figure 88)

• Lateral and anterolateral approaches to the hindfoot, and dorsolateral approaches to the mid-foot and forefoot. Place a sandbag under the buttock to help internally rotate the leg (see Figure 87). The access may be improved further by placing a side support against the opposite iliac crest and then tilting the table 20–30° towards the opposite side

• Dorsal approaches to the midfoot and forefoot. Rex the knee so that the foot lies with its sole on the table (plantigrade) (Figure 92). This position may be maintained by placing one or more pillows behind the knee

• Plantar approaches (Figure 93). Sit at the end of the table with the table raised. The table may also be tilted head-down (Trendelenburg position).

Considerations

• Ensure that any pressure areas are well-padded: the occiput, the sacral area, the heels.

• A thigh tourniquet may be used.

• Drape the leg free to allow full hip, knee and ankle movement.