Place the patient supine on the operating table (see Fig. 1-1). Partially exsanguinate the foot, either by elevating for a few minutes or by applying a soft rubber bandage loosely to the foot and binding it firmly to the calf. Then inflate a thigh tourniquet.

This approach is minimally invasive, and the small skin incision needs to be very accurately placed. Palpation of bony landmarks is insufficient and image intensification is usually used to help identify the internal bony architecture. To achieve a true lateral radiograph of the foot, roll the limb externally. To achieve a true anteroposterior radiograph of the ankle, bring the foot to the full dorsiflexed position (see Fig. 1-1).

Minimally invasive surgery demands careful preoperative planning, patient positioning, and very accurate skin incisions. Determine the position of the incision by using a lateral fluoroscopic image, an axial heel view, and an anteroposterior image. The starting point for the incision is determined by the intersection of two lines on the sole of the foot. The first line is drawn longitudinally through the ankle and hindfoot on the lateral image. This line runs through the center of the tibial medullary canal along its axis. The line crosses the talus and calcaneum to exit through the sole of the foot (Fig. 23-1A). The second line runs over the lateral column of the calcaneus and is determined on the longitudinal plantar view (Fig. 23-1B).