Fusion arthrodesis of the tibiotalar joint using iliac crest bone graft. The following steps are performed longitudinal skin incision over anterior ankle joint is made; dissection between extensor digitorum longus and extensor hallucis longus tendons is done; anterior tibial vessels and nerve is retracted medially; ankle joint capsule is detached from anterior margin of tibia; articular cartilage is removed from horizontal surface of the talus and tibia with osteotome; anterior iliac bone is harvested (as wide as ankle mortise and as long as anterior/posterior dimension of ankle); the graft is perforated with a drill; the ankle is manually distracted; the graft is hammered into place with wide face facing anterior; the wound is closed and a cast is applied from base of toes to proximal thigh with knee in 15 degrees of flexion.