Indications Provides exposure to ankle joint tarsal bones subtalar joint talonavicular joint and calcaneocuboid joint cuboid-metatarsal joints cuboid-cuneiform joints Approach Position supine can exanguinate leg if using tourniquet Incision begin incision anteromedial to fibula 5 cm proximal to ankle joint carry incision over ankle joint to base of fourth metatarsal may be extended both proximally and distally Superficial dissection incise fascia, superior and inferior extensor retinacula down to periosteum of distal tibia and ankle joint capsule identify and retract intermediate dorsal cutaneous branches of superficial peroneal nerve retract extensor tendons, deep peroneal nerve, and dorsalis pedis artery medially divide extensor digitorum brevis in direction of its fibers (or may detach proximal origin and reflect distally) Deep dissection expose ankle joint capsule expose talonavicular joint and calcaneocuboid joint (same plane) expose subtalar joint (must first remove lateral fat pad) if needed: extend dissection distally to expose joint between cuboid and 4th and 5th metatarsals if needed: extend dissection distally to expose joint between cuboid and third cuneiform Dangers Avoids most important vessels and nerves