Malunions of the fibula are caused by malreduction during initial surgical management or the result of nonoperative treatment of an unstable ankle fracture . They can cause significant changes in loading of the ankle and subsequently lead to arthritic changes. Timely recognition of abnormal anatomy and corrective osteotomy yields favorable results. The current review addresses the anatomy and biomechanics of the ankle and the effects of a malunited fibula fracture . The radiological workup is discussed as well as the technique of the osteotomy. Last, the authors highlight the expected outcome and possible complications for an optimal informed consent of the patient.