The foot and ankle are prepped to the surgeon's specifications.

An oblique linear skin incision is made within the skin tension lines 1.5 to 2.0 cm long over the sinus tarsi.

The incision is bluntly dissected with curved hemostats through the subcutaneous tissue to the anteriolateral aspect of the sinus tarsi. The interosseous ligament should be cut within the canalis portion of the sinus tarsi using tenotomy scissors. This is necessary for the implant to sit properly within the sinus tarsi. 

The number six trial sizer is inserted into the sinus tarsi from anteriolateral distal to posteriomedial proximal and the rearfoot is everted.

A guide wire may be placed into the cannula of the number six trial to ease in the placement of subsequent trail spacers.  

Sequentially, larger trial sizers are inserted into the sinus tarsi until the desired size is determined. The sizer is removed and the appropriate implant is selected, placed on the guide wire and advanced into the sinus tarsi using "two-finger tightness" technique. When resistance is felt the implant is in proper placement.  

The guide wire should be removed prior to the driver to help prevent movement of the implant. The driver is then removed and the incision is irrigated with copious amount of sterile solution. The incision is closed per the surgeon's choice.

Check the placement of the implant in the sinus by inserting your pinky finger. If the implant is not felt it is inserted deep enough. If the dorsal lateral corner of the implant is felt, that is acceptable as well, but if the full lateral face of the implant is felt, it has not been driven in deep enough. If after trying to advance the implant and the full face is still felt then the angle of insertion may be off or a smaller size implant is needed.