Positioning

The patient is in supine position with the heel of the foot resting on the very end of the operating table. The two main portals are the anteromedial and anterolateral portal. After making a longitudinal stab incision through the skin only, the subcutaneous layer is divided by a hemostat. Through the anteromedial portal, the 2.7-mm shaft with blunt trocar is introduced into the joint. The 2.7-mm arthroscope with an inclination angle of 30° is introduced. The instruments are introduced through the anterolateral portal. The procedure is performed under spinal or general anesthesia using a pneumotourniquet. In dorsiflexion, the dorsal aspect of the joint can be visualized. When synovitis is present, a shaver or whisker is used for removal. Osteophytes are resected by the abrader or small acromionizer. Manual distraction is sufficient to visualize the head of the metatarsal and basis of the first phalanx. Through the anteromedial portal, the arthroscope can be brought to the plantar side of the joint where the medial sesamoid bone can be seen.

Portals

The patient is in supine position with the heel of the foot resting on the very end of the operating table. The two main portals are the anteromedial and anterolateral portal. After making a longitudinal stab incision through the skin only, the subcutaneous layer is divided by a hemostat. Through the anteromedial portal, the 2.7-mm shaft with blunt trocar is introduced into the joint. The 2.7-mm arthroscope with an inclination angle of 30° is introduced. The instruments are introduced through the anterolateral portal. The procedure is performed under spinal or general anesthesia using a pneumotourniquet. In dorsiflexion, the dorsal aspect of the joint can be visualized. When synovitis is present, a shaver or whisker is used for removal. Osteophytes are resected by the abrader or small acromionizer. Manual distraction is sufficient to visualize the head of the metatarsal and basis of the first phalanx. Through the anteromedial portal, the arthroscope can be brought to the plantar side of the joint

Placement of the anteromedial and anterolateral portal.