Segmental bone loss in the foot and ankle—from infection, nonunion, avascular necrosis, or trauma—has long lacked reliable solutions, with historic femoral head allograft fusions achieving only approximately 50% union because revascularization often fails across defects larger than 2 cm. Newer 3 dimensional-printed custom metallic implants (titanium and cobalt chrome) bridge these defects with markedly higher integration rates (approximately 91% vs 61% for allografts). Total talus and hemitalus replacements restore hindfoot anatomy with promising short-term outcomes and good patient-reported measures. Success depends on correct implant sizing, robust beaming/plating fixation, and biomechanical planning for shear loaded medial and lateral colums.