Ankle joint sepsis is a serious pathologic entity that, if not effectively treated, can lead to significant dysfunction and morbidity. Minimal published data are available to guide the frequency and extent of surgical irrigation and debridement in patients with ankle joint sepsis. We report on a surgical treatment protocol used at our institution based on intraoperative joint staging. We present the case of a 68-year-old female with well-controlled diabetes who presents with ankle joint sepsis. She represents a typical patient treated by our standard approach. At approximately 1 year postoperatively, the patient reported minimal residual pain and had returned to near previous activity levels, despite an advanced stage of joint sepsis at the initial presentation. The treatment protocol provides supplemental guidance to assist regular clinical judgment in managing the septic ankle joint.