Restoration of physiological alignment of the distal tibia and thereby restoration of physiological loading of the ankle joint; joint preservation in asymmetric degenerative arthritis of the ankle. Congenital deformities of the distal tibia; acquired deformities of the distal tibia; asymmetric degenerative arthritis with partially preserved cartilage. Absolute contraindications comprise severe nicotine abuse, Charcot arthropathy, peripheral polyneuropathy, relevant peripheral arterial vessel disease, poor local soft tissue condition, acute infection and extensive cartilage damage grade3-4 in the Outerbridge classification in the complete joint. Medial and lateral open and closed wedge osteotomies and dome osteotomies of the distal tibia are used, and shortening, lengthening and derotating osteotomies of the fibula. For 6weeks, 15-20 kg partial weight-bearing in abelow knee cast or awalker orthosis; full weight-bearing depending on osseous healing after 9-12weeks postoperatively. Between July 2012 and May 2017, 15patients (10men, 5women) underwent asupramalleor osteotomy. Average age was 41.8years (range 17-63years) and the retrospective average follow-up was 28.7months (range 3-47months). Mean preoperative AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 54.3 (range 26-86) and postoperatively a mean of 74.2 (44-100). Preoperatively, 9patients had varus malalignment and 6patients valgus malalignment; overall, 4patients developed complications requiring surgical intervention (26.7%). Osteosynthetic material was removed in 60% of the patients.