Posterior Ankle and Hindfoot Arthroscopy

Hindfoot pain can be caused by any part of the posterior ankle anatomy with bony and soft tissue, including os trigonum, large posterior talar process, tenosynovitis of the flexor hallucis longus tendon, osteochondral lesions of the talus, subtalar arthritis and arthrosis, prominent calcaneus posterior process and free bodies, such as synovial chondromatosis. Because these structures are deeply situated and difficult to palpate, there remain diagnostic difficulties. Posterior ankle and hindfoot arthroscopy gives excellent access to such a posterior ankle compartment1, and it is regarded as the ideal diagnostic tool for accurate diagnosis of the hindfoot disorders. Furthermore, it is also regarded as an effective tool especially for the athletes who expect to return to their initial athletic activities with a shorter recovery time. The arthroscopic approach to the posterior ankle was first described by Parisien and Vangsness in 1985 as a subtalar arthroscopy2. In 2000, van Dijk advanced an epoch-making technique, a two portal endoscopic approach, which makes it possible to obtain broad field of vision and working space1. Recently, posterior ankle and hindfoot arthroscopy utilizing a two portal endoscopic approach has been developed and widely used for diagnosis and treatment of hindfoot disorders. In this part, the author describes the posterior ankle and hindfoot arthroscopy utilizing a two portal endoscopic approach.