Indications for posterior ankle arthroscopy and hindfoot endoscopy are mainly therapeutic and include treatment of a great variation of conditions like, but not limited to, posterior ankle impingement including os trigonum, osteochondral lesions, subtalar osteoarthritis, retrocalcaneal bursitis, Haglund’s deformity, flexor hallucis longus tendinopathy, Achilles tendinopathy, chronic Achilles tendon rupture, arthroscopically-assisted fracture treatment, and hindfoot coalitions. Posterior ankle arthroscopy is usually performed with the patient in the prone position, through posteromedial and posterolateral portals. Detailed knowledge of anatomy is crucial to avoid complications. Superficial anatomical landmarks are identified and marked before the skin incisions are made. To avoid complications, one should keep the instruments lateral to the flexor hallucis longus tendon, the direction of view should be lateral, and the direction of the instruments should be toward the interdigital web space between the first and the second toe. Overall complication rate is between 0 and 8.5%, most commonly neurological symptoms, such as dysesthesia and plantar numbness. Results depend on the indication.