The use of external fixation in the treatment of fractures dates from the early 1900s. Since then there has been a number of revolutionary advances in both frame design and application of external fixation. In addition to its utilization in the management of difficult foot and ankle fractures, external fixation is used for neuropathic joint (Charcot) management, ulcer/wound management, contracture correction, arthrodesis, limb salvage, bone transport, osteomyelitis, malunion, and nonunion. External fixation provides a rigid construct, permitting early weight bearing, minimal soft-tissue dissection, soft-tissue access, and gradual deformity correction, and may be the safest form of fixation in the presence of active infection. This article will review some of the different usages for external fixation in the foot and ankle.