Most foot deformities affecting children and adolescents can be managed non-operatively or with joint preserving procedures. Severe fixed deformities often require more comprehensive treatment, and triple fusion remains an option in these situations. Surgical decision making in electing for a triple fusion in this age group and in these rare conditions can be difficult. The primary goals of treatment are elimination of pain, correction of the deformity and maintenance of a plantigrade foot. This review aims to outline those situations where triple fusion is warranted, and describe our technique.