Background: Ankle arthrodesis for diabetic complications, such as osteomyelitis and Charcot neuroarthropathy (CN), constitute an entirely separate group that calls for different surgical approaches for successful outcomes. Diabetes mellitus is currently the most common cause of neuroarthropathy. Abnormal nociception and proprioception lead to progressive destruction of the joint. Ankle arthrodesis and ankle arthroplasty are the two common operative treatments used in end stage ankle arthritis (ESAA). Recent clinical evidence suggests that ankle arthroplasty leads to superior functional outcomes over ankle arthrodesis. Ankle arthrodesis is indicated for patients with ESAA that failed a minimum of 3 month of conservative treatment. Both internal and external fixation may be used in ankle arthrodesis. Retrograde intramedullary arthrodesis is typically reserved for arthrodesis of both the ankle and subtalar joints. Two standardized methods of ankle arthrodesis for ESAA is described here: Open and arthroscopic.