Hindfoot endoscopy for posterior ankle pain.

Hindfoot pain can be caused by a variety of pathologies, most of which can be diagnosed and treated with endoscopy. The main indications are posterior tibial tenosynovectomy, diagnosis of a longitudinal peroneus brevis rupture, peroneal tendon adhesiolysis, flexor hallucis longus release, os trigonum removal, endoscopic treatment of retrocalcaneal bursitis, endoscopic treatment of Achilles (peri)tendinopathy, and treatment of ankle joint or subtalar joint pathology. The advantages of endoscopic hindfoot surgery over open surgery are less morbidity, reduction of postoperative pain, outpatient treatment, and functional postoperative treatment. Optimal portal placement for each indication has been identified in a cadaver study. The approach for the flexor hallucis longus and os trigonum is particularly challenging because of the adjacent neurovascular bundle. A two-portal hindfoot approach with the patient in the prone position offers excellent access to the flexor hallucis longus. The posterior ankle compartment, os trigonum, and subtalar joint can be visualized and treated through this approach. In 240 consecutive procedures, no major complications were reported. The two-portal hindfoot endoscopy approach is a safe, reliable, and exciting method to diagnose and treat a variety of posterior ankle problems. Endoscopic calcaneoplasty for retrocalcaneal bursitis offers a good alternative to open resection. Experienced arthroscopic surgeons will find this technique rewarding.