Tibiotalocalcaneal arthrodesis is a salvage procedure. We report on the operative technique, the importance of addressing concomitant ankle and foot deformities when present and the outcomes (radiologic fusion rate, limb salvage rate, and global patient satisfaction) with a hindfoot arthrodesis nail. It was used for tibiotalocalcaneal arthrodesis on 63 consecutive patients (6 bilateral procedures). The minimum follow-up was 12 months; the mean age was 59 (range, 24 to 87) years, with 69% male. At 3 months, the fusion rate was 77.7% (49/63); 6-month fusion rate was 95% (60/63). The overall complication rate was 12.6% (8/63). There was a 100% limb salvage rate. Fifty-seven concomitant procedures were performed on 38 patients at time of nail insertion.