Major technologic advances in fiberoptic light transmission, video cameras, and instrumentation have allowed great advances in small-joint arthroscopy.1–5 Arthroscopy in particular is now a well established procedure for accurate diagnosis and operative management of certain ankle disorders.1–12 The small size of the ankle and significant periarticular soft tissue structures make placement and advancement of the arthroscope and instrumentation more difficult than in larger joints. Successful arthroscopy of the ankle requires knowledge of the regional anatomy and a familiarity with the available arthroscopic portals. This chapter highlights the gross and arthroscopic anatomy of the ankle as it relates to current arthroscopic techniques. Particular emphasis is placed on the anatomic relations of the important osseous and soft tissue structures to assist the reader in developing a safe, reproducible approach to arthroscopic treatment of ankle pathology.