The use of intramedullary rod fixation for tibiotalocalcaneal fusion is gaining popularity. Many methods of fixation have been employed in the past, but intramedullary fixation has been shown to achieve higher fusion rates, provide fixation along the weight-bearing axis, and control rotational deformities. The authors describe the history, indications, technical considerations, and postoperative care of patients treated with fixation using an intramedullary rod with interlocking screws.