Asymmetric ankle osteoarthritis (OA) may develop in patients with varus or valgus deformities. Pathologically altered load distribution in the tibiotalar joint leads to medial (varus) or lateral (valgus) tibiotalar joint degeneration. However, as more than half of the tibiotalar joint surface remains preserved, joint sacrificing procedures including total ankle replacement or ankle arthrodesis may not be the most appropriate treatment options. The short-term and mid-term results after realignment surgery, published in the current literature, are very promising with substantial pain relief and functional improvement observed postoperatively. Herein we describe our experience with supramalleolar realignment surgery in patients with asymmetric varus or valgus ankle osteoarthritis.