Coronal plane deformity following total ankle arthroplasty has been associated with poor clinical outcomes and early prosthesis failure. Neutral mechanical alignment and prosthetic joint stability must be achieved through meticulous surgical planning and precise technical execution. Cavovarus foot deformity and varus malalignment of the lower extremity is reviewed, with particular emphasis as it relates to total ankle arthroplasty. Correction of varus malalignment may be performed at the time of total ankle arthroplasty or as a 2-stage procedure. Surgeon experience, revision total ankle arthroplasty, and subtalar arthrodesis should be considerations when contemplating 2-stage varus correction.