Introduction: Arthrodesis is a salvage procedure for patients with a destroyed, painful ankle joint to restore pain-free ambulation. This study aimed at evaluation of the results of ankle arthrodesis using the Ilizarov external fixator to treat endstage tibio-talar arthritis. Patients and Methods: This retrospective study included 20 patients who had been treated with ankle fusion by Ilizarov fixator performed from December 2007 to January 2014. The mean age was 44.95 years. Eight patients were females. The underlying pathology was septic ankle destruction, posttraumatic osteoarthritis, and rheumatoid arthritis. Avascular necrosis of talus was present in three cases. Seventeen patients had previous surgical procedures with a mean of 2.15 surgeries. Five patients had a failed previous arthrodesis. Six patients had associated equinus deformity. The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind foot score was 26. Results: The mean follow up period was 28.15 months. The mean external fixation period was 15.75 weeks. Sound fusion was achieved in all patients without additional operative procedures. Infection was controlled in all septic ankles. Pin site infections were observed in seven cases. In three cases, wires or half-pins needed to be removed. One ankle was fused in mild varus. One patient reported moderate daily diffuse pain. The mean postoperative AOFAS Ankle-Hind foot score was 75.45. Patients reported functional satisfaction with the results. Conclusions: The use of the Ilizarov external fixator provides a successful salvage method that offers solid bony fusion, optimal alignment, and eradication of infection in complex ankle pathology or failed previous arthrodesis.