**2. Basics and clinical applications**

#### **2.1 Indications**

The indications of hindfoot endoscopy are posterior ankle joint pathologies including osteochondral lesions of the posterior talus, loose bodies, ossicles, posttraumatic calcification or avulsion fragment; posterior subtalar joint pathologies including osteophyte, loose bodies, osteoarthritis or intraosseous talar ganglion; periarticular pathologies including posterior ankle impingement syndrome, deltoid ligament avulsion, tenosynovitis or intratendinous ganglion of the flexor hallucis longus, tenosynovitis or partial rupture of the peroneal tendon and posterior tibial tendon, retrocalcaneal bursitis and entrapment of the tibian nerve within the tarsal tunnel3.

#### **2.2 Set-up and normal anatomy**

#### **2.2.1 Set-up**

Hindfoot endoscopy was performed under spinal lumbar anesthesia. The patient was placed in a prone position on an operating table (Figure 1).

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Fig. 3. Arthroscopic view of the posterior talocrural joint before distraction (left) and after

Fig. 2. Bandage distraction technique.

distraction (right).

1. Tibia; 2. Talus; 3. Calcaneus

Fig. 1. Position of the patient.

A small support was placed under the lower leg. A pneumotourniquet is inflated to a pressure of 300 mm Hg. An arthroscope 4.0 mm in diameter with a 30 degree angle and the irrigation of saline with a pressure of 50 to 80 mmHg is used. Although any distraction device may not be needed in most cases, the bandage distraction technique4 with a force of 78.4 Newtons (Figure 2) is beneficial in cases where it is needed to be widen the posterior talocrural joint (Figure 3).

A small support was placed under the lower leg. A pneumotourniquet is inflated to a pressure of 300 mm Hg. An arthroscope 4.0 mm in diameter with a 30 degree angle and the irrigation of saline with a pressure of 50 to 80 mmHg is used. Although any distraction device may not be needed in most cases, the bandage distraction technique4 with a force of 78.4 Newtons (Figure 2) is beneficial in cases where it is needed to be widen the posterior

Fig. 1. Position of the patient.

talocrural joint (Figure 3).

Fig. 2. Bandage distraction technique.

Fig. 3. Arthroscopic view of the posterior talocrural joint before distraction (left) and after distraction (right). 1. Tibia; 2. Talus; 3. Calcaneus

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Fig. 5. Split of the deep layer by mosquito clamp directing to the first web.

Fig. 6. Insert an arthroscope shaft with the blunt trocar directing to the first web.
