In order to maintain lateral ankle stability when performing a total ankle arthroplasty (TAA), there must be a lateral strut from an intact and competent distal fibula. The aim of the present case report is to describe an alternative approach to failed ankle arthrodesis with a staged custom fibular implant and subsequent TAA. At final follow-up of 36 months from index procedure, there was no reported nonunion about the hindfoot complex with adequate seating of the total ankle arthroplasty components and pain free patient ambulation. We hope this novel approach will add to the current body of literature and guide colleagues with broadened surgical options while approaching ankle arthrodesis.
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