Ankle fusion continues to be a widely used technique for treatment of degenerative conditions of the tibiotalar joint. The functional results are dependent on obtaining a solid arthrodesis. The authors have found an increased incidence of nonunion in certain patient populations. Specifically, the patients at high risk include the diagnoses: Avascular necrosis of the talus with or without collapse; nonunion of tibiotalar or subtalar arthrodesis; history of previous pseudoarthrosis from previous procedures in other anatomic locations; cigarette smoking, alcohol abuse or other metabolic disorders. The spine fusion and fracture literature show good clinical results using an implantable direct current electrical stimulator as an adjunct to internal fixation to enhance fusion and bone healing. In this manuscript the authors describe their indications and detailed technique for use of implantable bone growth stimulation as an adjuvant in selected high-risk patients groups. Early clinical results and common complications are also reported.