Charcot neuropathic osteoarthropathy (CNO) is painless, progressive, noninfectious, degenerative arthropathy affecting single or multiple joints and soft tissues of foot and ankle caused by an underlying neurological deficit. The primary indication for surgical correction is a nonbraceble, nonplantigrade foot, instability, and impending or established ulceration. The goal of surgical management is to provide a stable, ulcer-free, plantigrade foot that can accommodate therapeutic footwear for self-ambulation. The choice of implants in midfoot CNO can be a combination of plate and screws well beyond the area of deformity to achieve rigid stability and good alignment following the principle of a super construct. The deformities involving the talus and ankle joint require a Total contact casting (TCC) arthrodesis, preferably with an intramedullary nail. The choices for soft tissue coverage as an additional procedure for ulcer management are guided by anatomic location, size, depth of ulcer, condition of surrounding soft tissue, and underlying deformity.

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