There are many causes of ankle pain, the most common being ankle pain that occurs after repeated sprains or fractures, even when the patient is not sure how it was caused. The main manifestation is ankle pain. Initially, the ankle joint feels inactive, and the pain is relieved after a short period of activity in the morning. After several months of delay, the pain intensifies, the ankle joint feels abrupt, the activity is inflexible, and gradually the leg is pointing and a limping gait appears. The ankle joint is larger than normal bones, the synovial membrane is swollen, the joint function is limited to different degrees, and different degrees of friction sounds can be palpated during active or passive joint activities, with different degrees of deformity in the late stage. In the late stage, the ankle joint activity is obviously restricted. Acupuncture, tui-na, plasters and ointments did not work, and it was sometimes light and sometimes heavy. This is the time to seek medical attention. Often the patient has already taken an X-ray film and the local doctor says it is fine. However, as soon as the X-ray is taken, we find that the bone density of the tibial talocrural joint or the subtalar joint has increased and hardened (white on the X-ray), suggesting that there is damage to the articular cartilage. In some patients, the joint space has narrowed. Even the anterior tibial labrum shows significant osteophytes. In advanced cases, joint deformity and subluxation may occur. In older patients, sometimes doctors generalize by mere hyperplasia, which is completely wrong. A strictly standardized diagnosis should be ankle osteoarthritis, which can be divided into primary osteoarthritis and secondary osteoarthritis. The etiology of primary osteoarthritis still has different opinions. Some scholars believe that it is a chronic inflammatory disease, while others believe that it is a repair process of the synovial joint in response to various stimuli (including aging). Secondary osteoarthritis, on the other hand, is caused by post-traumatic fractures, dislocations, damage to articular cartilage, or stress concentrations due to joint deformities. The most common clinical condition is also secondary ankle osteoarthritis. How is osteoarthritis of the ankle treated? There are two clinical treatment options: conservative and surgical. Conservative treatment can be used in the early stage when ankle pain is not severe and can be tolerated. This includes reducing the burden on the joint, rest, physical therapy, wearing ankle brace, high-top shoes with appropriate padding on the outside and medication, which may be able to reduce the symptoms. If non-surgical treatment is not effective, surgical treatment needs to be considered. The surgical approach depends on the type of arthritis, where it occurs and how the disease affects the joint, and sometimes requires a combination of treatments. Common surgical options include surgical debridement, osteotomy, traction therapy, allograft bone grafting, joint fusion therapy, total ankle replacement, joint fusion therapy, and more. The most commonly used treatment option is joint fusion. It is now recognized as the “gold standard” for the treatment of severe ankle osteoarthritis. The goal is to eliminate pain and deformity and to allow the patient to walk pain-free out of bed. There is no or less functional impairment of the ankle joint after fusion, especially in patients with normal talocrural and transverse tarsal joints, as hindfoot joint motion can compensate for the stiffness of the ankle. Post-traumatic arthritis is the most common surgical indication for a fusion. Other conditions include severe pain and deformity secondary to infection, osteochondral injury, talar osteonecrosis, inflammatory arthropathy, and rheumatoid arthritis. The youngest patient we have treated had this procedure performed at the age of 19 and is still doing well and working outside the home. The youngest patient we have treated had this procedure performed at the age of 19 and is now doing well and working outside the home. This procedure is the final solution to pain in the elderly.