Place the patient supine on the operating table (see Fig. 3-1). If the patient will be undergoing both the anterolateral and anteromedial approach to the talar neck simultaneously, a sandbag should not be placed beneath the buttock. If the anterolateral approach is used in isolation, insert a sandbag under the buttock of the affected side to internally rotate the leg (see Fig. 7-1). After exsanguination, apply a tourniquet to the mid-thigh.

Palpate the lateral malleolus at the distal subcutaneous end of the fibula and the base of the fifth metatarsal, a prominent bony mass on the lateral aspect of the foot. Identify the alignment of the fourth ray of the foot by palpating the subcutaneous surface of the fourth metatarsal bone. Make an 8-cm straight incision on the anterolateral aspect of the ankle. Begin some 2 cm proximal to the ankle joint and 2 cm anterior to the anterior border of the fibula. Extend the incision distally in line with the fourth ray of the foot, staying medial to the styloid process of the fifth metatarsal (Fig. 13-1).

The internervous plane lies between the peroneal muscles (which are supplied by the superficial peroneal nerve) and the extensor muscles (which are supplied by the deep peroneal nerve).