Distal tibial malalignment can result from posttraumatic malunion, physeal disturbances, congenital or metabolic diseases, and degenerative arthritis. Malalignment leads to an altered load distribution across the joint leading to early ankle joint arthritis. If a substantial part of the joint is salvageable, ankle fusion or joint replacement is not always the best option. Realignment of the distal tibia with a joint-sparing supramalleolar osteotomy is a valuable procedure in correcting deformity at the distal tibia. The goal of a supramalleolar osteotomy is to restore axial alignment. Several studies have demonstrated the successes of the osteotomy in improving function and relieving pain.