Custom radiographically designed tibial and talar cutting guide system and instrumentalities including a tibial cutting guide position verification device is disclosed. A computer-based system and method for making the custom radiographically designed tibial and talar cutting guides is also disclosed. Further disclosed is an adjustable tibial reaming guide positioning system for allowing a position for reaming of a distal tibia to be adjusted during total ankle replacement surgery and, particularly, during total ankle arthroplasty for prostheses with an intramedullary stem.
