Most common osteotomy around the ankle is supra-malleolar osteotomy, primarily done as a definitive treatment of ankle arthritis or as a preventive treatment for congenital ankle deformity. Where talas is tilted either inner or outer side and produce uneven load on distal tibia, which can progress to osteoarthritis.

For varus deformities of ankle medial opening osteotomy or lateral closing with fibula osteotomy is done. For valgus deformity either medial closing osteotomy or lateral opening with fibula osteotomy is done. All these osteotomy is required to fix with a plate. Aim of this osteotomy is to shift the weight bearing from damaged cartilage surface to healthy cartilage surface.

Post-trauma especially mal united tibial plafond fracture can cause deformity. Malleolar fracture with syndesmotic injury not treated adequately can cause lateral shift of talus and eccentric loading of talar dome. This is a painful ankle and may cause arthritis in the long run. I established arthritis supra-malleolar osteotomy is a good salvage operation.