4 studies with 386 patients with Stage 3 posterior tibial tendon dysfunction (PTTD) were included in this systematic review and meta-analysis comparing double hindfoot arthrodesis vs triple hindfoot arthrodesis. Pooled outcomes of interest included union rates, complications, infection, blood loss, operative time, functional outcomes, and radiographic correction. The meta-analysis of two studies found no significant difference in union rates between double and triple arthrodesis, while functional improvement measured by American Orthopaedic Foot and Ankle Society (AOFAS) scores was also similar between groups. Overall, double hindfoot fusion appeared to provide comparable clinical and radiographic outcomes to triple fusion, with potential advantages such as shorter operative time.