Successful management of the Charcot foot is one of the most challenging undertakings faced by physicians. However, many times such patients undergo prolonged and attentive care only to develop further deformity, and in many cases succumb to amputation. Research in the past few years has yielded a new understanding of the Charcot process that should serve as the basis for improved therapeutic measures. The authors discuss these more recent developments and how this knowledge may be applied to better serve the patient. In addition, surgical reconstruction of the diabetic Charcot foot is introduced and discussed.