This chapter focuses on the surgical management of Charcot neuroarthropathy (CN), examining the advantages and disadvantages of surgical intervention. In the Diabetic Charcot Foot, a combination of Neuropathy/Vasculopathy/Diabetes leads to common deformity patterns, including AVN with fragmentation of the talus or dislocation (see Figs. 16.1 and 16.2). Patients requiring reconstruction are either those who have acute CN where total contact casting is failing or those where chronic deformities have developed, and the foot is at risk of ulceration and infection or has developed these complications already. Surgical relevant factors are an alteration of the position of neurovascular bundle, development of vascular insufficiency and tendons, and an assessment of bone stock as there are usually multiple geographical and bone defects.