The patient is placed in the supine position. A tourniquet is placed around the upper leg. Before anaesthesia, the patient is asked to actively invert the foot, so that the posterior tibial tendon can be palpated and the portals can be marked. Access to the tendon can be obtained anywhere along its course
Preferably a 2.7 mm scope is used for posterior tibial tendoscopy. This small- diameter short arthroscope yields an excellent picture comparable to the standard 4.0 mm arthroscope; however, it cannot deliver the same amount of irrigation fluid per time as the 4 mm sheath. This is important when a large diameter shaver is used. When a 4 mm arthroscope is used, gravity inflow of irrigation fluid is usually sufficient. A pressurized bag or pump device sometimes is used with the 2.7 mm arthroscope.
With the 2.7 mm arthroscope a 3.5 mm shaver is used; when the 4.0 mm arthroscope is used a 5.5 mm shaver is advised. Furthermore a probe and punches are useful, and in case of a mini-open procedure we use 3.0 Vicryl sutures.