The most important conversation around total ankle arthroplasty isn’t about implants — it’s about decisions, expectations, and how the patient actually wants to live. When active patients ask about fusion versus replacement, the answer is rarely binary. Foot alignment, hindfoot motion, stiffness, and deformity all matter — sometimes more than the ankle itself. In patients with cavovarus alignment and already limited foot motion, a fusion can leave them with a terminally stiff ankle in a system t