Ankle arthritis is a physically disabling condition, and its treatment can be both challenging and rewarding for the patient and the treating physician. Gait derangement is common in patients with ankle arthritis, and associated pain in the knee, hip, or back often contributes to general health problems. Arthrodesis, although not always perfect in outcome, can obtain a stable, pain-free ankle and dramatic improvement in the function and quality of life in appropriately selected patients. While the incidence of total ankle replacement is increasing, arthrodesis remains the procedure of choice for many patients with symptomatic ankle arthritis.