Aims and background: A bullet foreign body, especially if embedded in joint space, can cause multiple complications. Although there is still no standard treatment for retained bullet foreign bodies, we found in some literature that bullet removal is the best treatment option for intra-articular involvement. Achieving ankle stability is considered a priority after foreign body removal. Case description: We present a 48-year-old male with swelling and pain in his right ankle after falling from a parked motorcycle. The drop-foot gait pattern was also found. We later found from an X-ray examination that the patient had an untreated bullet foreign body embedded in his right ankle from an incident 20 years ago. Foreign body removal and tibiotalocalcaneal arthrodesis (TTCA) using retrograde intramedullary nail were performed to achieve ankle stability. Conclusion: Tibiotalocalcaneal arthrodesis (TTCA) using retrograde intramedullary nail performed in this particular case showed good clinical outcomes and a good return-to-work rate. Clinical significance: This case report revealed that bullet removal in the tibiotalar joint is a great treatment option for patients experiencing abnormal gait pattern and chronic pain. The utilization of retrograde intramedullary nail along with bone graft can be a promising option in cases with avascular necrosis of the talus to achieve a stable ankle fusion.