In contrast to arthroscopy, which has become the preferred technique to treat intra-articular ankle pathology, extra-articular problems of the ankle have traditionally demanded open surgery. Open ankle surgery has been associated with complications such as injury to the sural nerve or superficial peroneal nerve, infection, scarring, and stiffness of the ankle joint. The percentage of complications reported with open surgery for posterior ankle impingement (removal of os trigonum, scar tissue, hypertrophic posterior talar process, or ossicles) varies between 15 and 24%. The incidence of these complications has stimulated the development of endoscopic techniques. Endoscopic surgery offers the advantages related to any minimally invasive procedure, such as fewer wound infections, less blood loss, smaller wounds and less morbidity. Aftertreatment is functional, and surgery is performed on an outpatient basis.

Tendoscopy can be performed for the treatment and diagnosis of various pathologic conditions of the peroneal tendons, the posterior tibial tendon, and the Achilles tendon.