The unstable Charcot foot remains a challenge to even the most experienced surgeon. Reconstructive surgical management of the neuropathic Charcot foot is a valuable treatment option for the patient who has severe musculoskeletal deformity. Frequently, the unstable nature of this deformity prevents successful use of therapeutic shoes or braces. For these high-risk individuals, reconstructive surgery often is the only way to avoid amputation. With precise surgical technique, appropriate postoperative care, and meticulous patient compliance, stability can be restored to the dysfunctional foot. The management of the Charcot foot can be extremely rewarding for the patient and surgeon.