Septic ankle arthritis is a serious, limb threatening condition that requires a prompt and comprehensive treatment approach. Treatment of a septic ankle and/or hindfoot infection can be a challenging endeavor, often complicated by concomitant deformity and patient comorbidities that prolong healing time. Eradication of the infection and stabilization of the limb are fundamental concepts when performing septic fusion, often requiring staged procedures with various fixation methods. There is a paucity of literature outlining the approach to septic fusion of the ankle/hindfoot. Herein, we review current methods of septic ankle fusion while featuring an algorithmic approach for management of this challenging pathology.