Asymmetric ankle osteoarthritis (OA) is an increasingly recognized condition. It is imperative to differentiate between extraarticular and intraarticular deformity and to address these appropriately. Any associated instability and multilevel deformity must be recognized and addressed. Patients with intraarticular varus or valgus asymmetric OA have poorer outcomes and higher rates of recurrence when treated with standard techniques targeted at correction with traditional supramalleolar or inframalleolar techniques. Plafondplasty aims to correct the deformity at its center of rotation and angulation and is associated with low rates of recurrence, substantial postoperative pain relief, functional improvement, and a possible slowing of the degenerative process.