Ankle osteoarthritis constitutes a large burden to society and is a leading cause of chronic disability in the United States. Most commonly, it is post-traumatic, occurs in younger individuals, and is associated with obesity. This entity presents similarly to osteoarthritis of the other joints, with the typical nonspecific symptoms of stiffness, swelling, and pain. Radiographic investigation includes four weight-bearing standard views: antero-posterior and lateral foot, mortise view of the ankle, and a specialized view of the hindfoot. In this review, we covered epidemiology, anatomy and biomechanics, etiology, pathology, differential diagnoses, symptoms, physical examination, appropriate radiological investigation, as well as current treatment options and algorithms. Non-operative treatment options include weight loss, physical therapy, bracing, orthoses, pharmacologic treatments, corticosteroid injections, viscosupplementation, and biologic modalities. Viscosupplementation with hyaluronic acid has the most evidence-based support and has been shown to be safe and efficacious. For patients who have moderate to severe disease, surgery may be indicated. However, current surgical options are either associated with high rates of complications or restrict ankle range of motion (ROM). Early stages of the ankle osteoarthritis should be treated with the above-mentioned non-surgical methods, and once the disease progresses, surgical options can be utilized.