Background: This study is aimed to assess differences in the pattern of practice and choice of management of end-stage ankle arthritis among established Asia-Pacific foot and ankle surgeons. Materials and methods: A survey was presented to fellowship trained foot and ankle surgeons registered with their respective national orthopedic professional societies practicing in the Asia-Pacific region. The e-mail-based survey contained eight questions and participation in the survey was entirely voluntary. A Microsoft Excel spreadsheet was used to collate the data and was subsequently analyzed using Windows-based statistical software. Multiple choice questions and visual analog scales were primarily used to gather demographic data and surgeons’ choice of managing end-stage ankle arthritis. Surgeons were also presented with open-ended questions to gather information about operation times and surgical treatment choices for a variety of clinical scenarios. Results: The response rate to the survey was 100%. The practice pattern demographics of surgeons included in the study were primarily foot and ankle-focused. There was a varied response with regards to the number of total ankle replacements (TARs) carried out in the previous 1 year at the time of the survey, with 14 (67%) had not carried out any, two (10%) had carried out one ankle replacement, two (10%) had two ankle replacements, two (10%) had three ankle replacements, and one (5%) surgeon had carried out over five ankle replacements in the previous year. About six (75%) of the surgeons who answered surgical duration reported an average time of 120 minutes to perform the operation. Around four (80%) of the surgeons who answered associated procedures had also performed a soft tissue plication and osteotomy, and one (20%) had performed a soft tissue plication only. The number of surgeons who performed zero, one, two, three, and over five ankle fusions was the same as ankle replacements. In the question asking about the levels of satisfaction when performing a TAR, most (62.5%) had a satisfaction level of 7/10. Regarding open ankle fusion, the majority (61%) of surgeons had a satisfaction level of 8/10 or more. Most surgeons (81%) had a satisfaction level of 7/10 or above when performing an arthroscopic ankle fusion. Conclusion: The prevalence of patients with end-stage ankle arthritis requiring surgery presenting to foot and ankle specialists in the region is low. Among specialists in the region, open ankle fusion remains the procedure of choice for the surgical management of end-stage ankle arthritis with the highest degree of surgeon comfort and satisfaction. Though infrequently performed, open ankle fusion, TAR, and arthroscopic ankle fusion are performed with a high degree of operator satisfaction in the minority of surgeons who do perform these procedures. Evidence in the modern literature for ankle fusions vs TAR is reflected by current practice trends in the Asia-Pacific region.