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The purpose of this retrospective study was to evaluate the long-term results with a minimum of ten years follow-up of primary Bologna-Oxford (BOX) TAA. Between December 2004 and December 2009, 80 patients (82 ankles) underwent a primary BOX TAA performed by a single senior surgeon, expert in foot and ankle surgery. Pain and functional outcomes were analysed using Visual Analogue Scale (VAS) for pain, American Orthopaedic Foot Ankle Society (AOFAS) scoring system, Foot Functional Index Disability and Pain (FFI-Disability, FFI-Pain)