We　treated　a　57-year-old　female　with　modified　Takakura　stage　3B　varus　ankle　osteoarthritis.　Her　preoperative　talar　tilt　angle　was　21.3　degrees　The　patient　wished　to　avoid　ankle　joint　arthrodesis　or　replacement.　Therefore,　medial　opening　wedge　supramalleolar　osteotomy　with　fibular　osteotomy　was　used　for　her　varus　ankle　osteoarthritis.　Also,　fixed　medial　distraction　arthroplasty　was　performed　to　improve　her　talar　tilt.　After　3　months,　the　external　device　was　removed,　and　the　patient　was　allowed　partial　weightbearing　and　began　full　weightbearing　4　months　postoperatively　after　the　osteotomy　site　had　reached　bony　union　radiographically.　At　the　3-year　follow-up　visit,　a　radiograph　showed　the　medial　ankle　joint　space　enlargement　had　been　maintained.　The　talar　tilt　angle　had　decreased　to　3.3,　and　the　modified　Takakura　stage　had　improved　to　stage　1.　The　American　Orthopaedic　Foot　and　Ankle　Society　(AOFAS)　Ankle-Hindfoot　scale　score　had　improved　from　26　points　preoperatively　to　85　points　at　3　years　postoperatively.　Our　findings　suggested　that　good　clinical　and　radiologic　results　can　be　achieved　with　supramalleolar　osteotomy　combined　with　distraction　arthroplasty　in　the　treatment　of　varus　ankle　osteoarthritis　with　a　large　talar　tilt　angle.　(C)　2017　by　the　American　College　of　Foot　and　Ankle　Surgeons.　All　rights　reserved.