This shows the close relation between the Flexor hallucis longus tendon and the posterior tibial nerve. It emphasizes the importance of the FHL tendon as landmark in posterior ankle arthroscopy. The working area is always lateral to the FHL tendon, to avoid damage to the medially located neurovascular bundle.

Picture 1: Posterior arthroscopy of the left ankle.

Picture 2: During the removal of soft tissue to identify the FHL, the soft tissue covering the posterior tibial nerve, medial to the FHL tendon, was accidentely removed and the nerve appeared.

CLICK HERE for example of iatrogenic vascular damage and other pitfalls in posterior ankle arthroscopy.