BACKGROUND: Tibiotalocalcaneal arthrodesis (TTCA) is a salvage procedure for severe diseases involving ankle and subtalar joints. However, this procedure is often associated with postoperative complications related to preoperative comorbidities. The purpose of this study was to present the clinical and functional outcomes of a consecutive series of TTCA using an original operative approach based on minimal incision surgery (MIS). METHODS: Forty patients were followed prospectively for a mean (SD) of 31 (12.5) months. Clinical data, which included x-rays, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, SF-36 scores, and a patient satisfaction survey, were collected. A further 25 patients were examined retrospectively. RESULTS: In the prospective group (n = 40), the mean AOFAS score improved by 44.8 points 1 year after the intervention (95% confidence interval [CI], 40.6-48.9), and the SF-36 improved by a mean of 17.5 points (95% CI, 1.4-20.9) in the mental component summary (MCS) score and 11.5 points (95% CI, 8.3-14.7) in the physical component summary (PCS) score. In the prospective group, postsurgical pain correlated with MCS score (r = 0.47, P < .001). In the entire group, bony union (defined as radiographic consolidation and absence of clinical symptoms) was observed in 86% of cases. Two deep infections, 2 nonunions in patients with preoperative persistent ulcers, and 7 delayed unions were the major complications observed in the entire group. One patient required amputation. No cases of superficial infection, wound dehiscence, or deep venous thrombosis were recorded. CONCLUSION: To our knowledge, the present series represents the largest study on TTCA using MIS. The data obtained in the present study showed clinical and functional improvement after surgery and similar bony union rates as previously reported in the literature but with fewer complications related to the surgical wounds. LEVEL OF EVIDENCE: Level IV, case series.