Given the complex anatomy and function of the ankle, the management of chronic pathologies remains a challenge particularly in high-demand groups of patients such as athletes. Besides conventional X-rays for standard radiologic examination and MRI, nuclear imaging, mostly SPECT/CT, is becoming more and more important. In the last years, SPECT/CT has almost extruded simple scintigraphic bone scans in evaluation of complex bony hindfoot disorders and has renewed the interest in nuclear imaging for ankle pathologies. This is mainly due to its unique combination of detailed morphologic information from the CT and the clearly localised metabolic information of each specifi c bone or even each specifi c region of particular bones from the SPECT. This ability makes SPECT/CT a new important tool which adds substantial information to the data achievable from MRI examination. However, there is currently only scarce evidence about SPECT/CT around the ankle. This chapter summarises the current scientifi c knowledge, adds clinical examples and shows future directions to be elucidated to enhance the use of SPECT/CT around the ankle.