Ankle arthrocentesis may be performed at either the subtalar joint (lateral approach) or the tibiotalar joint (medial approach). The subtalar joint is entered just below the tip of the lateral malleolus with the foot perpendicular to the leg ( Fig.278-6). The needle should be directed medially toward the joint space.

FIG. 278-6. Arthrocentesis of the ankle, lateral approach.

The tibiotalar joint is approached with the patient supine and the foot initially perpendicular to the leg. This position facilitates the location of a sulcus lateral to the medial malleolus and medial to the tibialis anterior and extensor hallucis longus tendons ( Fig.. 27.8-7.). The foot is then plantar flexed with the needle entering the skin overlying the sulcus. The needle should be angled slightly cephalad as it passes between the medial malleolus and the tibialis anterior tendon.

FIG. 278-7. Arthrocentesis of the ankle, medial approach.

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