Ankle degenerative arthritis can be responsible of ankle pain and discomfort in athletes but also in non-athlete populations. Rest and physical therapy are the cornerstones of treatment. Indications for surgery include failure of non-surgical treatment with an inability to return to activities after a relatively long time of rehabilitation. Surgical intervention should be directed toward specific pathological lesions believed to correspond to the patient’s symptoms or that play a role in the complex pathophysiology. The physician must assess pain intensity, ankle impairment, sensorimotor control, athlete perception/readiness, and athletic/functional performance in order to make the decision about return to sport.