When more conservative treatments (such as pain medication, steroid injections, activity modifications/limits, walking aids, cushioned and specially designed footwear, and stabilizing braces) have failed, ankle arthrodesis may be performed.⁸ The goal of the procedure, commonly known as ankle fusion (as the tibia, fibula and talus are fused into one bone), is to relieve pain and maintain or improve function by eliminating motion in the arthritic joint. In younger more active patients ankle debridement, distraction arthroplasty and supramalleolar osteotomy (in near normal ranges of movement) are all options which aim to attempt to conserve the joint surface, and may be effective in selected cases. Arthroplasty (joint replacement) may also be offered in some cases.

As part of the fusion procedures, osteotomy (the surgical cutting or removal of a piece of bone to alter alignment) may be performed in the lower leg, with the use of external fixation. This procedure stabilizes the operative site, allowing the bones to heal together. In case of infection or very damaged soft tissues, external fixation is the preferred treatment.⁹