Seven patients with nonbraceable, neuropathic ankle joints have been successfully treated by tibiocalcaneal arthrodesis utilizing an adolescent condylar blade plate, large cannulated AO screws, and a special cancellous allograft mixture. All patients had fragmentation and partial resorption of the talus. This procedure was considered as an alternative to below-knee amputation. Goals were limb salvage and limited community ambulation. Criteria for proceeding with the fusion were a commitment by the patient to 6 to 8 months of nonweightbearing ambulation, a biopsy and culture of the talus revealing no evidence of infection, and a nonbraceable deformity of the foot and ankle that would otherwise require amputation. A toe-level Doppler index or a transcutaneous oxygen index of greater than 0.45 was required. All patients were treated initially in a total contact cast or bivalved total contact ankle-foot orthosis (AFO) until wounds and swelling were controlled and there was no erythema. Presence of an ulcer did not preclude surgery. The arthrodesis used a combination of 7.0-mm AO cannulated screws and an adolescent condylar blade plate. A special preparation of fresh-frozen, irradiated, cancellous allograft mixed with tobramycin and vancomycin powder was used. All ankles fused solidly in an average of 5.2 months. No infectious complications were encountered. Two patients developed a stress fracture of the tibia at the proximal aspect of the blade plate before use of a bivalved AFO. These healed with nonoperative treatment in 6 weeks. All patients were satisfied with their result at their latest follow-up (average 26.9 months).(ABSTRACT TRUNCATED AT 250 WORDS)