Arthroscopic surgery has given the foot and ankle surgeon the ability to identify pathology that can be missed on advanced imaging studies. Ankle fractures are a common injury that often only receives a plain radiograph prior to surgery. Arthroscopy, as part of the surgical fixation of ankle fractures, can demonstrate syndesmotic widening and osteochondral defects that otherwise may have been missed. Arthroscopic evaluation during surgical management of ankle instability can show significant osteochondral lesions or loose bodies. Arthroscopy is essential in the management of osteochondral defects of the tibia or talus, specifically in assessing the size and depth of the lesion, as well as the quality of the surrounding cartilage. Subtalar arthroscopic evaluation has been shown to be effective in confirming the diagnosis and assisting with treatment. When assessing peroneal tendon pathology, tendoscopy has shown promise in localizing and sometimes even treating peroneal tendon tenosynovitis and small tears. The advancements in the use of arthroscopy have given the orthopaedic surgeon the capability to diagnose and treat injuries that otherwise may have been missed with standard imaging studies.