Neuroarthropathy of the foot and ankle presents a series of challenges to the treating physician that requires an advanced understanding of not only the underlying disease process but also of the mechanics and pathomechanics of the foot and ankle. Traditionally, nonoperative care of the Charcot foot has been the mainstay of treatment, but recent studies have questioned the validity of this treatment algorithm. The concept of a ''super contruct'' has been introduced to describe techniques in which normal orthopaedic principles are abandoned to maximize stability and to bridge the area of Charcot dissolution. A superconstruct is defined by four factors: (1) fusion is extended beyond the zone of injury to include joints that are not affected to improve fixation, (2) bone resection is performed to shorten the limb to allow for adequate reduction of deformity without undue tension on the soft-tissue envelope, (3) the strongest device is used that can be tolerated by the soft-tissue envelope, and (4) the devices are applied in a position that maximizes mechanical stability. Three techniques have evolved to correct Charcot midfoot deformity: plantar plating, locked plating and axial screw fixation. This article reviews the principles of treatment and new operative techniques used for reconstruction.