This issue of Clinics in Podiatic Medicine and Surgery is the first of two dealing with Total Ankle Replacement, guest edited by Dr. Thomas Roukis. Article topics include: Controversies in total ankle replacement, Techniques for managing varus and valgus mal-alignment during total ankle replacement, The INBONE IIT total ankle replacement system, The SaltoT mobile bearing total ankle replacement system, and The START implant: Surgical approach and experience with the well-aligned and severely deformed ankle.