Some 3 to 5 cms distal from the fibula the tendons cross each other and again get divided by a membrane and a bony prominence. The achillotendoscopy for retrocalcaneal bursitis is performed in the prone position. Two portals are created both medial and lateral to the Achilles tendon at the level of the superior border of the os calcis. The 2.7 mm arthroscope is introduced through one of the two portals into the retrocalcaneal bursa. The operation is performed as an out-patient procedure under general, regional or local anaesthesia.
Local anaesthesia has the advantage of a possible dynamic investigation.
The tendon than can be palpated and the location of the portals can be drawn on the skin. When a total synovectomy of the posterior tibial tendon sheath is to be performed it is advisable to create a third portal some 3-4 cms distal from the distal portal. To prevent sinus formation the portals were closed using one monofihic suture. After treatment consists of pressure bandage and partial weight bearing for 2-3 days. Active ROM is advised from day 1.