The joint is directly visualized with the arthroscope. The intra-articular fracture is evaluated. The ankle is then inspected, performing a standard 21-point diagnostic arthroscopy.

First ray instability can be demonstrated by producing a dorsal-plantar translation of the first ray in relation to the intermediate column of the foot. Note the increased translation and also the abnormal first metatarsal motion occurring at the tarsometatarsal joint.

As the screwdriver is used in a counter-clockwise direction in the jig, distraction can be obtained at the joint.

The peroneal tendons must be visualized on approach and protected throughout the case. They are retracted plantar and posterior. Occasionally, as in this case, the tendons can be dislocated at the time of injury due to disruption of the superior peroneal retinaculum. To avoid iatrogenic injury, care must be taken to look for displaced tendons during the approach. Preoperative evaluation of radiographs (fleck sign) and CT imaging allows the surgeon to anticipate peroneal tendon dislocation prior to incision.

Postoperative dressing change for a patient after a correction of a crossover second toe, hallux valgus, bunionette, and hammer toe deformity of 2nd, 3rd, and 4th toes (same patient as shown in Figure 40.11) is demonstrated.

Following fixation of the fracture, the subtalar joint is assessed for motion. Direct visualization of the posterior facet during passive inversion and eversion will reveal potential mechanical blocks to motion.