Indications Excellent exposure to ankle joint midtarsal joint subtalar joint Disadvantage include danger of skin sloughing peroneal tendons usually need to be divided and repaired Approach Position supine with bump under buttock partial exsanguination (allows better visualization of neurovascular bundle) Incision begin just lateral to distal head of talus curve posteriorly to point 2.5 cm below tip of lateral malleolus curve proximally and run parallel to fibula and 2.5 cm posterior to it end 5-10 cm proximal to the lateral malleolus Superficial dissection incise fascia down to peroneal tendons and retract them posteriorly may divide peroneal tendons with Z-plasty for larger operative field and repair at end of case Avoid lesser saphenous vein and sural nerve which lay posterior to incision Deep dissection Divide calcaneofibular ligament and expose subtalar joint If desired may expose calcaneocuboid joint through distal end of incision If desired may divide talofibular ligaments and dislocate talus by medial traction to expose articular surface of the tibia Dangers Lesser saphenous vein Sural nerve