The number of alternative approaches for the variety of rearfoot and ankle procedures commonly performed is clearly as great as the imagination of the surgeon. To ensure that the incisional approach is to contribute to the overall success of the procedure, the right approach must be selected and properly performed. To facilitate this process, general principles of incision placement and performance in the rearfoot and ankle have been presented. Building on those principles, one can learn the various techniques, as well as their respective advantages and disadvantages. Finally, the discerning surgeon should be able to apply the information presented here to select and perform the right incisional approach. Furthermore, the same process may lead the surgeon to improvise and create a successful alternative.