Ankle fractures are the most common lower extremity fractures. In younger age groups these fractures occur more often in men than in women, but after menopause there is a female predominance. Foot fractures show a similar trend. The primary goal in the treatment of ankle and foot fractures is to obtain exact reduction and stable fixation to facilitate early mobilization and good functional recovery. However, the need for internal fixation to secure fracture reduction must be weighed against the risk of operating on osteoporotic bone which lacks the strength to hold screws and plates. In the elderly, the preoperative evaluation of the peripheral blood supply is essential to avoid wound healing complications. We review here the surgical treatment of ankle and foot fractures with special reference to elderly patients.