Current status and future perspectives of arthroscopic treatment for foot and ankle disorders: a narrative review

Abstract

Purpose: The prevalence of foot and ankle disorders continues to rise, driven by both an aging population and increased participation in sports. Since Takagi first introduced arthroscopy to the ankle in 1939, the field has evolved remarkably—particularly since the 1980s, with the development of smaller-diameter scopes and advanced instrumentation. This review aims to provide an updated overview of current arthroscopic techniques for common ankle pathologies, including osteochondral lesions of the talus (OLTs), chronic ankle instability (CAI), and ankle osteoarthritis. Additionally, it discusses clinical outcomes and future directions in the field. Current Concepts: Ankle arthroscopy is now established as a minimally invasive and indispensable modality for both diagnosis and treatment. In OLTs, procedures such as microfracture, retrograde drilling, osteochondral grafting, and autologous matrix-induced chondrocyte implantation have shown promising results. CAI is increasingly managed arthroscopically, particularly with modified Broström repairs that allow for simultaneous treatment of intra-articular lesions. In advanced osteoarthritis, arthroscopic ankle arthrodesis offers reduced soft tissue morbidity compared to open surgery, while achieving similar or superior fusion rates. Nevertheless, meticulous surgical planning and a thorough understanding of ankle anatomy are critical to minimize complications. Discussion and Conclusion: Although arthroscopic surgery offers clear benefits, the ankle’s narrow joint space and complex anatomy require advanced surgical proficiency. Standardized training programs and ongoing refinement of surgical techniques are essential. Emerging technologies—including high-resolution arthroscopy, augmented reality, biologic adjuncts, and regenerative therapies—are anticipated to further improve precision and long-term outcomes. With continued research and technological integration, ankle arthroscopy will maintain a central role in providing patient-specific, function-preserving care.