Distal traction may be applied to the great toe to open the joint space. The needle is inserted on the dorsomedial or dorsolateral surface ( Figure 6 ) . The needle should be angled 60 to 70 degrees to the plane of the foot and pointed distally to match the slope of the joint. The joint space is not deep below the skin surface. The physician should aspirate before injecting; the injectable agent should flow without major resistance when the needle is positioned properly in the joint space. Follow-up care is the same as that previously described.